Neonatal sepsis poses a serious threat to the life and health of newborns worldwide. Despite advances in diagnosis and treatment, it remains one of the primary causes of morbidity and mortality among infants [1]. This condition requires immediate recognition and adequate therapeutic intervention, as delay can have catastrophic consequences [2, 8].
What Is Neonatal Sepsis and Why Is It Dangerous?
Sepsis is a clinical syndrome resulting from a dysregulated host response to infection [2]. In newborns, such a response can be particularly unpredictable and rapid. Septic shock, a more severe form of sepsis, is characterized by cardiovascular dysfunction in the setting of infection [2].
Newborns, especially premature infants or those with low birth weight, are the most vulnerable to sepsis [1]. The severity and progression of the disease depend on multiple factors, including the timing of infection exposure, the infant's immune response characteristics, and the virulence of the pathogen [1]. In some cases, such as congenital syphilis, the infection may manifest with extensive multi-organ involvement, which significantly complicates the clinical picture and requires timely diagnosis and treatment [5].
There are two main types of neonatal sepsis:
- Early-onset neonatal sepsis: develops in the first 72 hours of life, often associated with infections transmitted from the mother during pregnancy or childbirth [1].
- Late-onset neonatal sepsis: manifests after 72 hours of life and may be associated with either hospital-acquired or community-acquired infections [1].
Signs and Symptoms of Neonatal Sepsis
Recognizing neonatal sepsis is one of the most challenging tasks in neonatology because its clinical manifestations can be extremely diverse and non-specific [5]. Infants cannot communicate how they feel, so doctors and parents must be especially attentive to any changes in their behavior and condition. Symptoms may include:
- Behavioral changes: lethargy, drowsiness, irritability, unusual crying.
- Thermoregulation disorders: fever (elevated temperature) or, conversely, hypothermia (low body temperature).
- Feeding problems: poor suckling reflex, refusal of breast or bottle, frequent regurgitation.
- Respiratory disorders: rapid or labored breathing, grunting, apnea (brief pauses in breathing).
- Skin changes: pallor, mottling, jaundice, rash.
- Gastrointestinal symptoms: abdominal distension, vomiting (including blood-tinged vomit, as in the case of hematemesis, which requires ruling out serious causes, including sepsis) [3], diarrhea.
- Cardiovascular disorders: tachycardia (rapid heart rate) or bradycardia (slow heart rate), low blood pressure.
It is important to remember that even seemingly localized manifestations, such as vomiting blood (hematemesis), can be part of a broad differential diagnosis that requires thorough investigation to rule out life-threatening conditions, including infections [3].
Diagnosis of Neonatal Sepsis
Timely and accurate diagnosis is critical for improving outcomes in neonatal sepsis [2, 8]. The diagnostic process includes a comprehensive approach:
- Clinical evaluation: careful examination of the infant and medical history taking, including information about the course of pregnancy and childbirth.
- Laboratory tests:
- Complete blood count (with differential white blood cell count and platelets).
- Blood chemistry panel (levels of C-reactive protein, procalcitonin, bilirubin, liver and kidney function parameters) [3].
- Blood culture — the "gold standard" for identifying the pathogen and determining its antibiotic susceptibility.
- Cerebrospinal fluid analysis (if meningitis is suspected).
- Other microbiological tests (urine cultures, throat, nasal, and rectal swabs as needed).
- Coagulation profile assessment to rule out blood clotting disorders [3].
- Instrumental methods:
- Ultrasound of the abdominal cavity and brain [3].
- Chest X-ray (if respiratory symptoms are present) [3].
- Screening: The development of new diagnostic methods and intrapartum screening programs (e.g., for group B Streptococcus) contributes to earlier risk identification [1, 6].
Modern Approaches to the Treatment of Neonatal Sepsis
The primary principle of treating neonatal sepsis is prompt recognition and immediate initiation of therapy [2, 8]. The treatment strategy includes:
- Antibiotic therapy: Antibiotics are the most frequently used medications in neonatal intensive care units [4].
- Empiric therapy: Initiated immediately after obtaining cultures, before results are available. The choice of antibiotics is based on epidemiological data, the most likely pathogens, and the infant's clinical condition [4].
- Targeted therapy: After culture results and susceptibility testing are obtained, antibiotics can be adjusted for more targeted treatment [4].
- It is important to consider the evolution of pathogen susceptibility to antimicrobial agents and pharmacokinetic characteristics in newborns to optimize dosages [4].
- Fluid resuscitation: Rapid and adequate fluid volume restoration is crucial, especially in septic shock, to maintain blood pressure and organ perfusion [2].
- Supportive care: Includes maintaining vital functions:
- Respiratory support (oxygen therapy, mechanical ventilation if necessary).
- Maintaining normal body temperature.
- Correction of metabolic disorders (hypoglycemia, acidosis).
- Cardiovascular support (inotropy agents in shock) [2].
- Comprehensive approach ("bundles of care"): Modern guidelines emphasize the importance of applying "care bundles" that include rapid diagnosis, adequate antibiotic therapy, and fluid resuscitation [2].
Despite efforts to develop new adjunctive therapies, the management paradigm for neonatal and pediatric septic shock has not changed significantly over the past 20 years, highlighting the importance of the basic principles of early and aggressive intervention [2].
Prevention of Neonatal Sepsis
Prevention plays a key role in reducing morbidity and mortality from neonatal sepsis. One of the most successful examples is intrapartum antibiotic prophylaxis (IAP) to prevent sepsis caused by group B Streptococcus (GBS). In the US, the implementation of IAP has led to a significant reduction in cases of perinatal GBS sepsis [6].
However, additional measures are required to prevent sepsis caused by other pathogens [6]. Important aspects of prevention include:
- Adequate antenatal care and screening of pregnant women for infections (e.g., syphilis), as congenital infections can lead to severe multi-system organ damage in newborns [5].
- Strict adherence to hygiene and asepsis rules in maternity hospitals and neonatal units.
- Early detection and treatment of maternal infections.
- Support for breastfeeding, which provides the newborn with protective antibodies.
Sources
- [1] Recognition and management of neonatal sepsis. (JAAPA : official journal of the American Academy of Physician Assistants, 2026) https://pubmed.ncbi.nlm.nih.gov/42190090/
- [2] Review of safe and effective pharmacotherapy in pediatric and neonatal septic shock. (Expert opinion on pharmacotherapy, 2025) https://pubmed.ncbi.nlm.nih.gov/41045461/
- [3] Hematemesis in a 4-week-old newborn: clinical reasoning and outcome following empirical acid suppression. (Case reports in pediatrics, 2026) https://pubmed.ncbi.nlm.nih.gov/42553515/
- [4] Medications for the prevention and treatment of neonatal sepsis. (Clinics in perinatology, 2019) https://pubmed.ncbi.nlm.nih.gov/31010563/
- [5] Severe early congenital syphilis with multi-organ involvement in a premature newborn: a case report. (Reports (MDPI), 2026) https://pubmed.ncbi.nlm.nih.gov/42496511/
- [6] Prevention of neonatal sepsis. (Clinics in perinatology, 2005) https://pubmed.ncbi.nlm.nih.gov/16085022/
- [8] Recognition, diagnosis, and management of severe pediatric sepsis and septic shock in the emergency department. (Pediatric clinics of North America, 2018) https://pubmed.ncbi.nlm.nih.gov/30446051/
The information in this article is for reference purposes only and does not replace professional medical advice. Always consult a qualified specialist for diagnosis and treatment.