Attempts have been made to see whether it is possible to risk stratify newborns in order to decide if a newborn can be safely monitored at home without treatment despite having a fever. One such attempt is the Rochester criteria. Signs and symptoms
The signs of sepsis are non-specific and include:
Body temperature changes
Breathing problems
Diarrhea
Low blood sugar (hypoglycemia)
Reduced movements
Reduced sucking
Seizures
Bradycardia
Swollen belly area
Vomiting
Yellow skin and whites of the eyes (jaundice). hemorrhagic rashA heart rate above 160 can also be an indicator of sepsis, this tachycardia can present up to 24 hours before the onset of other signs. Risk factors
A study performed at Strong Memorial Hospital in Rochester, New York, showed that infants ≤ 60 days old meeting the following criteria were at low-risk for having a serious bacterial illness:
generally well-appearing
previously healthy
full term (at ≥37 weeks gestation)
no antibiotics perinatally
no unexplained hyperbilirubinemia that required treatment
no antibiotics since discharge
no hospitalizations
no chronic illness
discharged at the same time or before the mother
no evidence of skin, soft tissue, bone, joint, or ear infection
White blood cells (WBCs) count 5,000-15,000/mm3
absolute band count ≤ 1,500/mm3
urine WBC count ≤ 10 per high power field (hpf)
stool WBC count ≤ 5 per high power field (hpf) only in infants with diarrheaThose meeting these criteria likely do not require a lumbar puncture, and are felt to be safe for discharge home without antibiotic treatment, or with a single dose of intramuscular antibiotics, but will still require close outpatient follow-up. One risk for Group B streptococcal infection (GBS) is preterm rupture of membranes.
The mother is not the only one who can contract the bacteria that contributes to sepsis. The child can contribute to the onset of sepsis through multiple factors. Mothers contribute to the risk through a variety of ways like diets during pregnancy and potential intake of foods that are contaminated, through invasive procedures like amniocentesis and cervical cerclage, or contamination of bacteria in the vaginal canal. Infants can contribute to early-onset sepsis through prematurity, congenital anomalies, complicated birth or instrument assisted birth, and low APGAR scores. Testing for neonatal sepsis is done because of how little it physically presents itself in babies. Infants showing no signs of neonatal sepsis will have a sepsis workup done only if concerning factors are shown. Only a small percentage of infants will have a sepsis workup done. Of this small population only 3% to 8% will show positive cultures. Research
Trials of probiotics for prevention of neonatal sepsis have generally been too small and statistically underpowered to detect any benefit, but a randomized controlled trial that enrolled 4,556 neonates in India reported that probiotics significantly reduced the risk of developing sepsis. The probiotic used in the trial was Lactobacillus plantarum. A very large meta-analysis investigated the effect of probiotics on preventing late-onset sepsis (LOS) in neonates. Probiotics were found to reduce the risk of LOS, but only in babies who were fed human milk exclusively.