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Early-Onset Neonatal Infection

What is Early-onset Neonatal Infection?

Most babies are born fit and healthy. However, some may unfortunately develop an infection before, during or shortly after birth. Newborn babies are at greater risk of infection as their immune system (which normally fights infection) is not fully developed. When a baby develops an infection in the first 72 hours of life, this is called early onset neonatal sepsis (EONS). EONS is rare cases are potentially serious and even life-threatening.

When does the healthcare team suspect early-onset infection?

There are multiple risk factors for infection, which include:

• Baby being born early (less than 37 weeks).
• Signs of infection in the birthing parent before or during labour.
• Bacteria in the birth canal such as Group B Streptococcus (GBS)
• The mother’s waters being broken for more than 24 hours prior to delivery.

Possible signs of early onset infection in the newborn baby include:

• Breathing difficulties
• Jaundice (yellow coloured skin and eyes)
• Abnormal temperature
• Low blood sugar levels
• Jitteriness or floppiness
• Altered behaviour (excessive crying or being very sleepy)
• Poor feeding or vomiting.

Based on these risk factors and our team’s assessment of the baby’s condition, we may either:

• Observe the baby closely, or
• Investigate your baby for suspected infection by taking blood tests and starting them on antibiotics in the vein (intravenous).
• Antibiotics (cefotaxime) are given through a cannula (a plastic catheter which stays in the vein) twice a day.
• Cefotaxime is considered very safe for newborn babies, even when mothers have an allergy to antibiotics including penicillin. It does not tend to cause any short or long term side effects in newborn babies and will not affect their immune system or ability to fight infections naturally.

How do you detect infection?

The medical team will discuss all these tests with you.

Blood culture: a sample of blood is put in conditions where bacteria could grow if present. This takes up to 48 hours, and if positive, confirms evidence of infection.

Infection Marker (C-reactive protein, CRP): A protein that is produced when the body tries to fight against infection. Although it does not confirm infection, it helps to guide our management. This is taken once at the beginning of treatment and is repeated at least once to check its trend.

The baby may need a chest X-ray if s/he has any breathing difficulties.

If we strongly suspect infection, your baby may need a lumbar puncture to rule out meningitis (an infection that affects the meninges – the tissue covering the brain and spinal cord).

What is a lumbar puncture?

A needle is inserted between the lower vertebrae (spinal bones) to withdraw the fluid that bathes the spinal cord. Sucrose (sugar water) will be given for pain relief  during this procedure where needed. This fluid will be looked at under the microscope for traces of infection and cultured to see if any bacteria grow.

This procedure is done only on babies who become unwell, where there is a strong suspicion of infection, or if they grow a bacteria in their blood.

Will I be able to stay with my baby and feed them as I choose?

With careful monitoring and timely treatment, it should be possible for your baby to stay with you on the postnatal ward even if antibiotic therapy is needed. You can feed your baby according to your wishes. We have a team that helps parents who choose to breastfeed, and we support parental choice and involvement.

In a few cases of newborn infection, admission to the neonatal unit will be needed so we can give your baby extra care.

How long will my baby need treatment?

If your baby remains healthy, the infection markers are reassuring and the blood culture is negative, we may stop the antibiotics after 36 hours of treatment. 

If your baby is unwell, or a bacteria is found in the blood or spinal fluid, or if we have a strong reason to suspect infection, your baby will require a longer course of antibiotics. We will discuss this with you in detail.
 

What should I do once I go home?

Once discharged, your baby should be treated the same as any other baby, including breast feeding as you wish.

However, if tests done during your pregnancy show you carry Group B Streptococcus (GBS) bacteria, there is still a small risk of the baby developing a late infection, even if antibiotics were given straight after birth. This is possible up to six weeks after birth. Signs of infection in newborn babies can be hard to spot, but include:

• Changes in behaviour such as inconsolable crying (this is out of the ordinary persistent prolonged crying)
• Your baby being listless or unusually floppy
• Your baby having problems feeding or tolerating feeds
• Your baby being unusually cold or hot even if the environment is not
• Breathing difficulties
• Change in skin colour – including being pale or developing jaundice (yellow coloured skin, eyes or gums).

You should carry on monitoring your baby at home for any of these signs and if you have any concerns contact your midwife, GP or if an emergency go to your local hospital Emergency Department (ED) as soon as possible.

Your GP will receive a letter explaining why your baby needed antibiotics. Please remember to register your baby with your GP practice as soon as you can.

References

NICE (2021). Neonatal infection: antibiotics for prevention and treatment, (NG195). NICE

Large print and other languages

This information can be made available in alternative formats, such as easy read or large print, and may be available in alternative languages, upon request. For more information, speak to your clinical team.

এই তথ্যগুলো সহজে পড়া যায় অথবা বৃহৎ প্রিন্টের মত বিকল্প ফরম্যাটে পাওয়া যাবে, এবং অনুরোধে অন্য ভাষায়ও পাওয়া যেতে পারে। আরো তথ্যের জন্য আপনার ক্লিনিক্যাল টিমের সাথে কথা বলুন।

Na żądanie te informacje mogą zostać udostępnione w innych formatach, takich jak zapis większą czcionką lub łatwą do czytania, a także w innych językach. Aby uzyskać więcej informacji, porozmawiaj ze swoim zespołem specjalistów.

Macluumaadkaan waxaa loo heli karaa qaab kale, sida ugu akhrinta ugu fudud, ama far waa weyn, waxana laga yabaa in lagu heli luuqaado Kale, haddii la codsado. Wixii macluumaad dheeraad ah, kala hadal kooxda xarunta caafimaadka.

Bu bilgi, kolay okunurluk veya büyük baskılar gibi alternatif biçimlerde sunulabilir, ve talep üzerine Alternatif Dillerde sunulabilir. Daha fazla bilgi için klinik ekibinizle irtibata geçin.

یہ معلومات متبادل فارمیٹس میں دستیاب کی جا سکتی ہیں، جیسا کہ پڑھنے میں آسان یا بڑا پرنٹ  اور درخواست پر متبادل زبانوں میں بھی دستیاب ہو سکتی ہیں۔ مزید معلومات کے لیے، اپنی کلینکل ٹیم سے بات کریں'۔

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Reference:  BH/PIN/1090

Publication date: August 2021

All our patient information leaflets are reviewed every three years.

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