Infectious Disease and Sepsis
Early-onset sepsis
Risk factors include GBS colonization, rupture of membranes 18 hours or more, maternal temperature 38 degrees C or higher, chorioamnionitis, and prematurity. Obtain a blood culture and CBC; perform a lumbar puncture when sepsis is suspected or the infant is unstable. Start ampicillin plus gentamicin. If the infant is well and cultures are negative, antibiotics can stop at 36-48 hours; bacteremia usually treats 7-10 days and meningitis 14-21 days. Adequate intrapartum GBS prophylaxis reduces early-onset disease.
Congenital and late-onset infection
TORCH infections include syphilis, cytomegalovirus, toxoplasmosis, rubella, and herpes simplex virus. HSV may present with vesicles, seizures, lethargy, or sepsis-like illness; use CSF PCR and start acyclovir 20 mg/kg every 8 hours. Congenital syphilis needs evaluation and IV penicillin. Hepatitis B: vaccine plus HBIG within 12 hours. HIV: maternal antiretroviral therapy and avoidance of breastfeeding when formula is safe.
Worked example
A term infant born after 26 hours of ruptured membranes to a GBS-positive mother with inadequate prophylaxis develops grunting at 4 hours. Reasoning: evaluate with CBC, blood culture, and LP; start ampicillin and gentamicin immediately. Do not wait for CRP to decide.
Traps
- Relying on a normal CRP or CBC to exclude early-onset sepsis.
- Missing HSV in an afebrile infant with seizures.
- Treating a positive surface culture as sepsis without clinical correlation.