Sepsis is a serious infection usually caused by bacteria — which can originate in many body parts, such as the lungs, intestines, urinary tract, or skin — that make toxins that cause the immune system to attack the body's own organs and tissues.
Sepsis can be frightening because it can lead to serious complications that affect the kidneys, lungs, brain, and hearing, and can even cause death. Sepsis can affect people of any age, but is more common in:
- infants under 3 months, whose immune systems haven't developed enough to fight off overwhelming infections
- the elderly
- people with chronic medical conditions
- those whose immune systems are compromised from conditions such as HIV
If your infant has a rectal temperature of 100.4º Fahrenheit (38º Celsius), seems lethargic, irritable, uninterested in eating, or seems to be having difficulty breathing or appears ill, call your doctor right away.
In an older child, symptoms may include a fever; your child may also seem lethargic, irritable, confused, have trouble breathing, have a rash, appear ill, or may complain that his or her heart feels like it's racing. Call your doctor right away if your child has these symptoms.
Sepsis occurs when a serious infection causes the body's normal reaction to infection to go into overdrive. With sepsis, bacteria and the toxins they create cause changes in a person's body temperature, heart rate, and blood pressure, and can result in dysfunction of the body's organs.
Signs and Symptoms
Sepsis in newborns can produce a wide variety of symptoms. Frequently, these babies "just don't look right" to their caretakers.
Symptoms of sepsis in newborns and young infants include:
- disinterest or difficulty in feeding, or vomiting
- fever (above 100.4º Fahrenheit [38º Celsius] rectally) or sometimes low, unstable temperatures
- irritability or increased crankiness
- lethargy (not interacting and listless)
- decreased tone (floppiness)
- changes in heart rate — either faster than normal (early sepsis) or significantly slower than usual (late sepsis, usually associated with shock)
- breathing very quickly or difficulty breathing
- periods where the baby seems to stop breathing for more than 10 seconds (apnea)
- change in skin color — becoming pale or blue
- jaundice (when the skin and eyes look yellow)
- decreased amount of urine
Older children who have sepsis might have a fever, vomiting, a rash, change in skin color, trouble breathing, feel like their hearts are racing, or may be lethargic, irritable, or confused. A child with sepsis may have started with an infection such as cellulitis or pneumonia that seems to be spreading and getting worse, not better.
Causes of Sepsis
Bacteria are almost always the cause of sepsis in newborns and infants. Bacteria such as E. coli, Listeria monocytogenes, Neisseria meningitidis, Streptococcus pneumoniae, Haemophilus influenzae type b, Salmonella, and Group B streptococcus (GBS) are the more common culprits in sepsis in newborns and infants younger than 3 months.
Premature babies receiving neonatal intensive care are particularly susceptible to sepsis because their immune systems are even more underdeveloped than other babies, and they typically undergo invasive procedures involving long-term intravenous (IV) lines, multiple catheters, and breathing through a tube attached to a ventilator. The incisions an infant gets for catheters or other tubes can provide a path for bacteria, some of which normally live on the skin's surface, to get inside the baby's body and cause an infection.
In some cases of sepsis in newborns, bacteria enter the baby's body from the mother during pregnancy, labor, or delivery. Some pregnancy complications that can increase the risk of sepsis for a newborn include:
- maternal fever during labor
- an infection in the uterus or placenta
- premature rupture of the amniotic sac (before 37 weeks of gestation)
- rupture of the amniotic sac very early in labor (18 hours or more before delivery)
Some bacteria (GBS in particular) can be acquired by the newborn during delivery — 15 to 30% of pregnant women carry the bacterium for GBS in the vagina or rectum, where it can be passed from mother to child during delivery.
Diagnosing and Treating Sepsis
Because symptoms of sepsis can be vague in infants, laboratory tests play a crucial role in confirming or ruling out sepsis:
- Blood tests (including white blood cell counts) and blood cultures may be taken to determine whether bacteria are present in the blood. Other blood tests may be done to see how well certain organs, such as the liver and kidneys, are functioning.
- Urine is usually collected by inserting a sterile catheter into the baby's bladder through the urethra for a few seconds to remove urine; this will be examined under a microscope and cultured to check for the presence of bacteria.
- A lumbar puncture (spinal tap) may be performed, depending on the baby's age and overall appearance. A sample of cerebrospinal fluid will be tested and cultured to determine if the baby could have meningitis.
- X-rays, especially of the chest (to make sure there isn't pneumonia), are sometimes taken.
- If the baby has any kind of medical tubes running into the body (such as IV tubes, catheters, or shunts), the fluids inside those tubes may be tested for signs of infection.
Sepsis, or even suspected cases of sepsis in infants, will be treated in the hospital, where doctors can closely watch the child and administer strong antibiotics intravenously to fight the infection.
Typically, doctors start infants with sepsis on antibiotics right away — even before the diagnosis is confirmed. If needed, they may start them on IV fluids to keep them hydrated, blood pressure medication to keep their hearts working properly, and respirators to help them breathe.
Although there's no way to prevent all types of sepsis, some cases can be avoided, namely the transmission of GBS bacteria from mother to child during childbirth. Pregnant women can have a simple swab test between the 35th and 37th weeks of pregnancy to determine if they carry the GBS bacteria.
If a woman tests positive for GBS, she can receive intravenous antibiotics during labor. It is best if these antibiotics are given at least 4 hours before delivery, so women who are GBS positive may need to go to the hospital earlier in labor than others.
Women are at higher risk of carrying GBS if they have a fever during labor, if the amniotic sac ruptures prematurely, or if they had other children with sepsis or other diseases triggered by GBS, such as pneumonia or meningitis. A woman who has not been tested for GBS, but has one of these risk factors, can receive IV antibiotics during labor to lower the risk of transmission to her child.
Another way to help prevent some types of sepsis is through vaccination. Immunizations routinely given to infants today include vaccinations against certain strains of pneumococcus and Haemophilus influenzae type b that can cause sepsis or occult bacteremia, an infection of the blood.
Hand washing can go a long way toward preventing infection. Also make sure that people who come near your baby are not sick and have been fully vaccinated. For children with indwelling medical devices, such as catheters or long-term IV lines, make sure to follow the doctor's directions for cleaning and accessing the site.
When to Call the Doctor
Symptoms of sepsis can be very difficult to identify in newborns and young infants, so call your doctor immediately or seek emergency medical care if your baby shows any of these symptoms:
- vomiting or difficulty or continued disinterest in feeding
- fever (100.4º Fahrenheit [38º Celsius] and above rectal temperature) in newborns and young infants
- labored or unusual breathing
- change in skin color (paler than usual or mildly bluish) or a rash
- listlessness or lethargy
- change in the sound of the baby's cry or excessive crying
- change in baby's muscle tone — either seeming too stiff or especially floppy
- a slower or faster heart rate than usual
- bulging or fullness of the "soft spot" on the baby's head
- decreased amount of urine
- any type of behavior or appearance that concerns you
If your older child has fever, vomiting, a rash, trouble breathing, change in skin color, feels like his or her heart is racing, or is lethargic, irritable, or confused, call the doctor or get emergency medical care immediately.
These signs don't necessarily mean a child has sepsis, but it's important to let the doctor know about symptoms to make sure an infection is caught before it becomes more severe.
Reviewed by: Larissa Hirsch, MD
Date reviewed: July 2008