Remember to consider undiagnosed congenital heart disease when faced with a
decompensating neonate, whose presentation may be identical to a patient with
sepsis. Many of the congenital cardiac anomalies will manifest in the first 24- 48
hours of life,
with clinical picture resembling early-onset sepsis. In the first week of life, as the
ductus arteriosus closes, other duct dependent cardiac anomalies, such as aortic
coarctation, may be confused for late-onset sepsis.[ 26 ] Having a high index of
suspicion for any of these lesions expedites diagnosis and provides appropriate
referral and care.
Early-Onset Neonatal Sepsis:
Infection may be both a cause of and a result of premature deliveries. This is
specifically true in the case of early onset sepsis, which the AAP defines as
sepsis affecting neonates within 72 hours of birth. These infections are
contracted via trans-placental route prior to delivery or from the birth canal during
vaginal birth. Risk factors for early onset sepsis include:[1 6 ]
a) Chorioamnionitis (as defined by maternal fever >38°C and at least one of
the following: maternal leukocytosis, maternal tachycardia, fetal
tachycardia, uterine tenderness, foul odor from the amniotic fluid)
b) Prolonged rupture of the membranes (18-24 hours)
c) Premature rupture of membranes
d) Prematurity
e) Maternal colonization with gram negative organisms and GBS
The organisms most commonly responsible for early onset sepsis are:[ 17 ]