Infections in the neonatal period – types

Proven content

The neonatal period is the most difficult stage in a newborn’s life. A helpless newborn baby often loses when faced with reality, and especially when exposed to infection. This is due to the insufficiently developed immune system of the newborn, and the main component protecting the child against infections in the first months are antibodies provided by the mother during pregnancy and breastfeeding.

Infections are a very big problem in the neonatal period and are one of the main causes of death in this period. In most cases, infection occurs in the first days of life. According to statistics, infections occur in 1-5 out of 1000 live born newborns.

Classification of infections in newborns

The source of infection of a newborn baby may be: the mother or the environment, which is why we most often distinguish two groups of infections:

intrauterine (perinatal) infections

nosocomial infections – develop during a newborn’s stay in hospital or show up immediately after leaving the hospital

Taking into account the moment of appearance of symptoms from childbirth, we can distinguish infections:

1. very early – up to 12 hours after childbirth and the main source of infection is the mother; characterized by a mortality of less than 10%
2. early – 1-3 days of life; mainly perinatal (intrauterine) infections; high mortality from 15 to 50%
3. late – from 4 days of age to 3 months – the mother is rarely the source of infection; more often the environment; mortality 10-20%
4. very late – over 3 months of age – environmental infections, mortality below 10%

Factors that increase the risk of infection in the newborn

on the mother’s side

premature rupture of the membranes (more than 24 hours before delivery)

fever during childbirth

abnormal smell of amniotic fluid

urinary infection

on the part of the newborn

1. prematurity (under 37 weeks of pregnancy)
2. low birth weight (less than 1500)
3. low Apgar score (less than 5 in the first minute; less than 7 in the fifth minute)
4. accelerated baby’s heart rate (over 160 / min)
5. male gender

on the part of the environment (hospital)

1. stay in the neonatal intensive care unit
2. prolonged hospitalization
3. surgical procedures
4. invasive treatments; e.g. intubation, vascular lines (cannulas, central catheters)
5. use of antibiotics
6. quality of medical care (e.g. lack of hand hygiene; large number of patients in a small area, insufficient bacteriological control of the ward)

The greater the number of factors, the greater the risk of infection and the risk of death of the newborn.

The most common forms of infections in the neonatal period

pneumonia

it is the most common form of infection and occurs in 20-30% of newborns alive. The etiological factors depend on the period of infection: in intrauterine infections these are most often group B streptococci (Streptococcus agalactiae), Escherichia coli, Listeria and Chlamydia trachomatis; staphylococci, Pseudomonas aeruginosa and Klebsiella pneumoniae play a major role in nosocomial infections; while in the child’s home environment, pneumonia is mainly caused by viruses, pneumococci and Haemophilus influenzae.

Symptoms of neonatal pneumonia are often nonspecific and different from that of an adult; often occur: apnea, rapid breathing, shortness of breath, rattling or coughing, the appearance of purulent discharge in the respiratory tract, fever is rare.

The diagnosis of neonatal pneumonia is mainly based on the chest X-ray and positive cultures of respiratory and / or blood secretions. The basic treatment is antibiotic therapy and supportive care.

Meningitis

They occur in up to 3 in 1000 liveborn babies and cause 4% of neonatal deaths. Early meningitis is caused by maternal etiological factors, incl. Streptococcus agalactiae, Listeria monocytogenes or Escherichia coli serotype K1. However, the most common causes of late infections are gram negative multiresistant bacteria from the hospital environment. Staphylococci play an important role in meningitis in newborns with defects in the nervous system.

Symptoms of meningitis in newborns are often non-specific and should be suspected, among others, by irritability, drowsiness, reluctance to eat, decreased muscle tone, convulsions, vomiting, hyperaesthesia, apnea, bulging and rippling of the crown or a sharp increase in the circumference of the head.

Diagnostics is based on an abnormal image of the cerebrospinal fluid and the results of microbiological tests. Treatment is reduced to antibiotic therapy and supportive care. About 50% of newborns with meningitis develop permanent neurological complications, such as hearing loss, epilepsy, paresis, speech disorders and hydrocephalus.

sepsis

it is the most severe form of infection with a very high mortality rate. Sepsis is a systemic inflammatory response of the body to an infection and is not an independent disease; can develop from pneumonia, meningitis, or any other infection. In the most severe form of sepsis, many organs are damaged and cause shock. Symptoms of sepsis in a newborn baby may be very subjective in the first stage or be very violent right away: apnea, rapid breathing, reluctance to suck, abdominal distension, significant drop in body temperature or fever, rash, ecchymosis on the skin, decreased physical activity, convulsions, jaundice , cyanosis.

The diagnosis is made on the basis of a number of tests: morphology, biochemistry, assessment of inflammation indicators and microbiological tests (blood cultures). Treatment must be started as soon as possible and includes supportive care and antibiotic therapy. Treatment is carried out in the intensive care unit.

conjunctivitis

This infection is found in about 2% of newborns and most often has the nature of chemical conjunctivitis, as a complication of the prophylactic use of 1% silver nitrate (Crede procedure). Among the infectious factors, bacteria play the main role: Chlamydia trachomatis, Neisseria gonorrhoeae, Escherichia coli and viruses from the Herpes group.

Infection most often occurs during childbirth. One of the factors contributing to inflammation is an obstruction of the tear ducts. Symptoms include purulent discharge from the eye, eyelid swelling and redness, conjunctival redness. In most cases, the diagnosis is made on the basis of the clinical picture, while eye swabs for bacteriological tests are most often sent when the treatment is not effective. Treatment is reduced to the use of topical antibiotics in the form of ointments or drops.

urinary tract infections

This type of infection occurs in about 1% of full-term newborns and in about 3-5% of premature or low birth weight newborns. The factors contributing to urinary tract infections include: urinary tract defects, prematurity, male sex, neurogenic bladder and the presence of a catheter in the urinary bladder. The most common etiological factor is Escherichia coli. Less commonly, infections can be caused by staphylococci, bacteria of the genus Klebsiella, Proteus or Pseudomonas.

Urinary tract infections can take the form of asymptomatic bacteriuria, cystitis or pyelonephritis. The clinical symptoms are non-specific: frequent urination, irritability, reluctance to suck, vomiting, inhibition of normal weight gain, prolonged jaundice or diarrhea. Diagnosis is mainly based on bacteriological urine culture. Treatment includes appropriate antibiotic therapy.

Untreated urinary tract infection can lead to sepsis.

Prevention of infections in newborns

The basic preventive measures include:

1. preventing premature births
2. prophylaxis of infections associated with premature rupture of the membranes
3. prophylaxis of perinatal infections
4. determining the carrier status of potentially pathogenic microorganisms in a pregnant woman (group B streptococcus, chlamydia, mycoplasma, etc.)
5. a short stay in the hospital after childbirth
6. breast-feeding
7. proper care of the newborn (skin protection, care of the umbilical cord stump, etc.)