Affiliations: Children's and Women's Health Centre of British
Columbia, Vancouver, BC, Canada | Department of Pediatrics, University of British
Columbia, Vancouver, BC, Canada | School of Population and Public Health, University of
British Columbia, Vancouver, BC, Canada
Note: [] Correspondence: Dr. Rebecca Sherlock, Children's and Women's
Health Centre of British Columbia, Vancouver, BC, Canada. E-mail:
rsherlock@cw.bc.ca
Abstract: The aim of this paper is to highlight the current trends in the
epidemiology, investigation, management and prognosis of neonatal sepsis and
septic shock. Despite the historical prevalence of group B streptococcal
neonatal infections, due to Centers for Disease Control and Prevention
guidelines for the prevention of perinatal group B streptococcal disease,
Escherichia coli is currently the most common organism isolated in
early-onset neonatal sepsis. Furthermore, there is increasing evidence that
antibiotic resistant strains are on the rise. With respect to late-onset
neonatal sepsis, coagulase-negative Staphylococcus is responsible for the
majority of late-onset infections, followed by Candida species. An
evolving pathogen likely to increase in prevalence is methicillin-resistant
Staphylococcus aureus. The clinical presentation of sepsis varies
while the presentation of septic shock consists of respiratory distress and
poor perfusion especially in the context of antenatal risk factors. There exist
a number of ancillary investigations that can be useful in the evaluation of a
neonate with sepsis, including C-reactive protein, interleukin-6 and
procalcitonin. The utility of these are discussed. The mainstays of management
of a neonate with septic shock include empiric then definitive antibiotic
therapy, cardiovascular support with fluids and/or inotropes and respiratory
support. The prognosis and outcomes for infants with septic shock are guarded
and neurodevelopmental functioning may be impaired in survivors.
