Neonatal Infections Explained-Causes, Signs, and Treatment 

Introduction: 

Infections remain a significant cause of neonatal morbidity and mortality, accounting for nearly one-third of neonatal deaths. These infections may be either superficial or systemic in nature1,3.

1.Superficial Infections:

a).Omphalitis: It is characterized by redness, induration, or pus discharge around the umbilicus. It often results from unhygienic cord care practices and, if untreated, may progress to systemic sepsis1. 

Localized omphalitis (redness <1 cm, no signs of sepsis) should be treated with antiseptic cleaning and topical 0.5% gentian violet four times daily1. Severe cases (redness >1 cm or sepsis signs) necessitate systemic antibiotics1.

b).Oral Thrush: presents as white, patchy, non-removable lesions on the tongue and mucosa, often leaving haemorrhagic points when scraped. Treatment involves topical antifungals like nystatin or clotrimazole four times daily post-feeding1,2.

c).Conjunctivitis in neonates may be due to bacterial, viral, or chlamydial causes. Differentiation from conditions like sticky eyes or blocked nasolacrimal ducts is essential2. Purulent discharge and inflammation suggest conjunctivitis, warranting topical antibiotics. Gonococcal infections require systemic therapy to prevent blindness1,2.

2. Systemic Infections (Neonatal Sepsis):

Neonatal sepsis includes septicaemia, pneumonia, and meningitis caused by bloodborne pathogens1,3. Common organisms include Escherichia coli, Staphylococcus aureus, Klebsiella, and hospital-acquired pathogens like Acinetobacter and Pseudomonas3.

Early-Onset Sepsis (EOS)

Occurs <72 hours post-birth, usually from maternal genital flora. Risk factors include low birth weight (LBW), prolonged rupture of membranes, foul-smelling amniotic fluid, multiple vaginal exams, maternal fever, and meconium aspiration. EOS frequently presents as pneumonia1,3.

Late-Onset Sepsis (LOS)

Appears ≥72 hours post-birth and is often nosocomial or environmentally acquired. Risk factors include poor cord care, non-breastfeeding, skin infections, and invasive procedures. Presentation includes pneumonia, meningitis, or septicemia1,3 

Clinical Features

Symptoms are often non-specific: poor feeding, lethargy, poor cry, hypothermia, vomiting, apnea, abdominal distension, or cyanosis. Pneumonia may present with fast breathing and chest retractions. Meningitis may be silent but can show high-pitched cry, seizures, or bulging fontanelle1,3.

Diagnosis

Diagnosis relies on high clinical suspicion and investigations. Sepsis screen includes total leukocyte count <5000/mm³, absolute neutrophil count <1800/mm³, I/T ratio >0.2, CRP >1 mg/dl, and micro-ESR >15 mm/h. Positive screen: ≥2 abnormal parameters1.

Lumbar puncture is mandatory unless sepsis is unlikely and the baby is asymptomatic. CSF values vary with gestation 1,3.

Treatment

Prompt therapy is vital. Supportive care involves temperature regulation, oxygen support, fluid/electrolyte management, and early enteral feeding with breast milk. Parenteral nutrition and vitamin K are also indicated1,2.

Antibiotics are initiated empirically after blood cultures in suspected cases. Empiric therapy differs by sepsis type and setting:

• Community-acquired: Ampicillin + Gentamicin

• Hospital-acquired: Ampicillin/Cloxacillin + Amikacin or Cefotaxime1,3.

Therapy is adjusted based on culture/sensitivity results. Overuse of antibiotics can promote resistant strains, so rational use is essential1.

Monitoring and Prognosis

Continuous monitoring of vitals, feeding, perfusion, and urine output is crucial. Prognosis depends on birth weight, gestational age, organism type, resistance pattern, and timely therapy. Mortality remains high (45–58%) in India1,3.

Author: Ram Sir

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