Neonatal sepsis and septic shock: Current trends in epidemiology and management

Abstract

The aim of this paper is to highlight the current trends in the epidemiology, investigation, management and prognosis of neonatal sepsis and septic shock. Despite the historical prevalence of group B streptococcal neonatal infections, due to Centers for Disease Control and Prevention guidelines for the prevention of perinatal group B streptococcal disease, Escherichia coli is currently the most common organism isolated in early-onset neonatal sepsis. Furthermore, there is increasing evidence that antibiotic resistant strains are on the rise. With respect to late-onset neonatal sepsis, coagulase-negative Staphylococcus is responsible for the majority of late-onset infections, followed by Candida species. An evolving pathogen likely to increase in prevalence is methicillin-resistant Staphylococcus aureus. The clinical presentation of sepsis varies while the presentation of septic shock consists of respiratory distress and poor perfusion especially in the context of antenatal risk factors. There exist a number of ancillary investigations that can be useful in the evaluation of a neonate with sepsis, including C-reactive protein, interleukin-6 and procalcitonin. The utility of these are discussed. The mainstays of management of a neonate with septic shock include empiric then definitive antibiotic therapy, cardiovascular support with fluids and/or inotropes and respiratory support. The prognosis and outcomes for infants with septic shock are guarded and neurodevelopmental functioning may be impaired in survivors.

Keywords

Neonate - sepsis - shock - GBS - inotropes - prognosis