Neonatology

Neonatal Sepsis and Infections

Neonatal sepsis is a life-threatening condition characterized by a systemic inflammatory response to bacterial, viral, or fungal infections occurring in the first twenty-eight days of life. It remains a major contributor to neonatal morbidity and mortality, particularly in low-resource settings. Neonatal infections are typically classified as early-onset, occurring within the first seventy-two hours of life and often transmitted vertically from the mother, or late-onset, which typically arises from nosocomial or community exposure. Common pathogens include Group B Streptococcus, Escherichia coli, Klebsiella species, Staphylococcus aureus, and in some regions, fungi such as Candida albicans. Risk factors for neonatal sepsis include premature birth, prolonged rupture of membranes, maternal infections, low birth weight, and invasive medical procedures. Clinical signs are often nonspecific and may include temperature instability, respiratory distress, lethargy, feeding intolerance, and hypotension. Timely diagnosis requires a high index of suspicion and relies on laboratory tests such as blood cultures, complete blood count, C-reactive protein levels, and procalcitonin, although none are definitive alone. Advanced molecular diagnostics and rapid multiplex polymerase chain reaction testing are improving early detection. Empirical antibiotic therapy is initiated promptly and then adjusted based on culture results and sensitivity patterns. In resource-limited settings, delays in diagnosis and inappropriate antibiotic use contribute to higher mortality and antimicrobial resistance. Prevention strategies include maternal screening for Group B Streptococcus, sterile delivery practices, and judicious use of central lines and other invasive equipment. The use of probiotics, early breastfeeding, and immune-boosting strategies also show promise in reducing infection risk. Neonatal sepsis requires a coordinated response involving neonatologists, microbiologists, infection control teams, and intensive care specialists. Continued research into host-pathogen interactions, antibiotic stewardship, and vaccine development is essential to reduce the global burden of neonatal infections.