Sepsis of Newborns.

Neonatal sepsis: causes, symptoms and treatment

Neonatal sepsis is a serious illness that can lead to death. Premature babies are most susceptible to it. In this article we will consider the etiology, pathogenesis, clinical picture and methods of treatment of neonatal sepsis.

Causes of neonatal sepsis

The causative agents of neonatal sepsis are various pathogenic and opportunistic microorganisms, such as staphylococcus, salmonella, Escherichia coli and blue-necked bacilli, Klebsiella, Proteus, Listeria and others. Infection of the fetus and newborn can occur in the ante-, intra- and postnatal periods. An important role is played by acute and chronic infectious diseases in the mother, various obstetric interventions, a long anhydrous period, endometritis, and the presence of other purulent-inflammatory foci in the mother (purulent mastitis, etc.).

Predisposing factors are intrauterine hypoxia, intracranial birth trauma, immaturity of the newborn, damage to the newborn's skin during obstetric operations and manipulations such as intubation, catheterization of the subclavian and umbilical veins, etc. Viral infection plays a major role in the generalization of the process. The entry gates are often the wound surface on the skin, mucous membranes, the umbilical wound and umbilical vessels, as well as intact skin and mucous membranes of the upper respiratory tract and gastrointestinal tract.

Pathogenesis of neonatal sepsis

In intrauterine sepsis, the source of infection is usually localized in the placenta or some organ of the pregnant woman. Often the entrance gate and the primary septic focus cannot be determined. The process can occur both in the form of septicemia (mainly in premature, weakened full-term infants) and in the form of septicopyemia. Septicemia is characterized by intoxication of the body without local purulent-inflammatory foci, while with septicopyemia, pyemic foci are detected (abscesses, phlegmons, osteomyelitis, pneumonia of a destructive type with pleural complications, purulent meningitis, otitis media and others).

Clinical picture

As a rule, sepsis in a newborn is severe and can have various forms: acute, subacute and chronic. The clinical picture can be varied and depends on the form of the disease, the age and condition of the newborn, as well as on the causative agent of the infection.

The main symptoms of neonatal sepsis are:

1. increase in body temperature or decrease to normal;
2. disorders of the cardiovascular system (tachycardia, bradycardia, hypotension);
3. respiratory dysfunction (shortness of breath, cyanosis);
4. liver dysfunction (jaundice, hepatomegaly);
5. impaired renal function (oliguria, anuria);
6. nervous system disorder (excitement, apathy, convulsions, coma);
7. the presence of purulent-inflammatory foci (abscesses, phlegmon, pneumonia, etc.).

Diagnosis of neonatal sepsis

Diagnosis of neonatal sepsis is based on the clinical manifestations of the disease and the results of laboratory and instrumental studies. Blood, urine, sputum, punctures of purulent foci and other biological materials are examined for the presence of infectious agents, antibodies, markers of inflammation, etc. Instrumental methods (ultrasound, radiography, computed tomography) make it possible to identify purulent-inflammatory foci and assess the condition of internal organs.

Treatment of neonatal sepsis

Treatment of sepsis in newborns should be comprehensive and prescribed depending on the form of the disease, the age and condition of the newborn, as well as the sensitivity of the pathogen to antibiotics.

The main treatments for neonatal sepsis include:

1. antibacterial therapy, which is prescribed immediately after identifying symptoms of sepsis and the results of bacteriological examination;
2. infusion therapy aimed at maintaining hemodynamics and correcting disturbances in the water-electrolyte and acid-base balance of the body;
3. respiratory support (oxygen therapy, mechanical ventilation);
4. symptomatic therapy (antipyretics, analgesics, sedatives, anticoagulants, etc.).

The prognosis of neonatal sepsis depends on the form of the disease, the timeliness and adequacy of treatment, as well as the age and condition of the newborn. In case of severe sepsis, complications are possible, such as organ necrosis, multiple organ failure