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Saturday, January 30, 2016

CAUSES OF SEPSIS IN BABIES & CHILDREN




Sepsis is when the immune system responds to an infection by attacking the body's own organs and tissues. The infection can originate in many body parts, including the lungs, intestines, urinary tract, or skin. Sepsis causes the body's normal reaction to infection to go into overdrive. Bacteria from the infection and the toxins they create can change a person's body temperature, heart rate, and blood pressure, and prevent the body's organs from working properly.

Sepsis may lead to serious complications that affect the kidneys, lungs, brain, and heart, and can even cause death. Sepsis can affect anyone at any time but it does tend to strike more often people at the extremes of life, the very old and the very young. As a result, children, particularly premature babies and infants, can be more susceptible to developing sepsis.

Once sepsis sets in, if left untreated, it can progress to septic shock and death. Worldwide, one-third of people who develop sepsis die. Many who do survive are left with life-changing effects, such as post-traumatic stress disorder (PTSD), chronic pain and fatigue, and organ dysfunction (don’t work properly) and/or amputations.

SIGNS AND SYMPTOMS
Sepsis in newborns can produce a variety of symptoms. Frequently, these babies "just don't look right" to their caretakers. Symptoms of sepsis in newborns and young babies include:

- Disinterest or difficulty feeding, or vomiting
- Fever (above 100.4°F [38°C] or higher rectally) or sometimes low 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, patchy, and/or blue
- Jaundice (when the skin and eyes look yellow)
- Rash
- Decreased amount of urine
- Bulging or fullness of the soft spot on the baby’s head

Older infants and children who have sepsis might have fever, vomiting, rash, change in skin color, trouble breathing, feel like their heart is racing, or feel 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/or getting worse, not better.

CAUSES OF SEPSIS
Bacteria are almost always the cause of sepsis in newborns and infants. Bacteria such as group B streptococcus (GBS), Escherichia coli, Listeria monocytogenes, Neisseria meningitidis, Streptococcus pneumoniae, Haemophilus influenzae type b, and Salmonella are common culprits in sepsis in newborns and infants younger than 3 months old.
Premature babies receiving neonatal intensive care are particularly at risk for sepsis because their immune systems are more underdeveloped than other babies'. And they usually undergo invasive procedures involving long-term intravenous (IV) lines, various catheters or tubes, and breathing through a tube attached to a ventilator. The incisions an infant gets during the placement of 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 SEPSIS
Because symptoms of sepsis can be vague in infants, laboratory tests play a crucial role in confirming or ruling out sepsis:
BLOOD TEST: Blood tests (including white blood cell counts and blood cultures) are done to see whether bacteria are in the blood. Other blood tests may be done to see how well certain organs, such as the liver and kidneys, are functioning.
URINE TEST: A urine test is usually done by temporarily inserting a sterile catheter into the baby's bladder through the urethra to collect a small sample of pee; this will be examined under a microscope and cultured to check for bacteria.
LUMBAR PUNCTURE: A lumbar puncture (also called a spinal tap) may be done, depending on the baby's age and overall appearance. A sample of spinal fluid will be tested and cultured to see if the baby could have meningitis, an infection of the membranes covering the brain and spinal cord.
X-RAY: X-rays, especially of the chest (to check for pneumonia), are sometimes taken.
MEDICAL TUBES: 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 might be tested for signs of infection.
TREATMENT
Sepsis, or even suspected cases of sepsis, will be treated in the hospital, where doctors can closely watch the child and administer antibiotics intravenously (through an IV) to fight the infection.
Usually, doctors start infants with sepsis on antibiotics right away, even before the diagnosis is confirmed. If needed, babies might receive IV fluids to keep them hydrated, blood pressure medication to keep their hearts working properly, and respirators to help them breathe.

PREVENTING SEPSIS
There's no way to prevent all types of sepsis. But some cases can be avoided by preventing 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 (IV) antibiotics during labor. It is best if these antibiotics are given at least 4 hours before delivery, so women in labor who are GBS positive should go to the hospital early.

  • Women are at greater 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, may receive IV antibiotics during labor to lower the risk of transmission to her newborn.

  • 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.

  • Regular hand washing is the best way to prevent infection. Also, make sure people who are sick don't get close to your baby. Children and adults handling young infants should be up-to-date with vaccinations.

  • For children with medical devices like catheters or long-term IV lines, make sure to follow the doctor's directions for cleaning and accessing the device.





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