During and after birth, infants are at risk of contracting serious infections. Many neonatal infections can lead to devastating consequences if not detected and treated soon after birth.
Serious acute infections affect 2 in 1,000 live births, but babies who weigh less are more likely to develop an infection (Borton & Tidy, 2013). Infants’ immune systems are not fully developed, placing them at an increased risk of contracting an infection that adults would be more likely to fend off (The Meningitis Centre, n.d.). Many of the different infections are similar in how they are acquired, their symptoms, and their treatments.
There are many different types of neonatal infections. Some common neonatal bacterial infections include septicemia, meningitis, syphilis, pneumonia, tuberculosis, or urinary tract infections (UTI). Common neonatal viral infections include HIV, herpes, rubella, or varicella (i.e., chickenpox; Borton & Tidy, 2013; Martin et al., 2006).
An infant may suffer an infection while in utero, during delivery, or after birth. Before birth, a baby can acquire an infection from the mother which can result in a spontaneous abortion, growth restriction, congenital malformation, or other problems (Caserta, 2013d). These include infections like rubella, hepatitis, or syphilis.
It is more common, however, for an infant to acquire an infection during delivery; if the baby passes through an infected birth canal they may contract infections such as the herpes simplex virus (HSV), human immunodeficiency virus (HIV), or cytomegalovirus (CMV; Caserta, 2013d).
A third way an infant can obtain an infection occurs after delivery from contact with an infected mother or health provider. One example of this is HIV, which can be transmitted through breastfeeding after birth.
The symptoms of different infections are very similar. Some general symptoms include changes in body temperature or heart rate, breathing problems, sleepiness, vomiting, diarrhea, and decreases in movement and activity (Caserta, 2013c, 2013d; Lee, 2013). Symptoms in infections such as meningitis may be more severe and include seizures and other central nervous system problems (Caserta, 2013a; Lee, 2013).
Management of Infections in the Newborn
After noticing symptoms of infection, doctors should order diagnostic tests to determine if the baby is in fact infected and the type of infection. Without diagnostic tests, it is often difficult to determine if a baby is infected because infections in neonates tend to lack definitive clinical features and do not always have localizing features (Borton & Tidy, 2013). However, because of their immature immune system, undiagnosed infections can quickly spread through a newborn and cause severe damage.
Many different tests can be performed to help diagnose a neonatal infection (Borton & Tidy, 2013). Physicians may order blood tests such as a full blood count (FBC), blood cultures, and tests specific for viral DNA. Urine tests may also be used such as a urine culture or urea and electrolytes tests. It may be helpful to obtain ear, nose, and throat swabs and infection site swabs as well. Lumbar punctures involve removing a sample of the child’s cerebral spinal fluid and are also commonly performed to diagnose infections. If the baby is showing signs of respiratory distress, a physician may order a chest x-ray or arterial blood gases. Lastly, one test that may be beneficial is a polymerase chain reaction (PCR), which is a DNA sequence analysis that can detect bacterial and viral infections within hours rather than the days required for results of bacterial, fungal, and viral cultures (MedicineNet, 2015).
Treatment of Infections in the Newborn
Most neonatal infections are treated with antimicrobial therapy (Caserta, 2013d). For bacterial infections, drugs similar to those used to treat the specific infection in adults are used to treat infants. The dose and frequency of the drug is simply adjusted based on the baby’s age and weight, and it is usually given to the baby through an IV. If it is a bacterial skin infection, an antibacterial powder or cream may be used (Borton & Tidy, 2013). Viral infections are typically treated with an antiviral medication called acyclovir and are given through an IV (Borton & Tidy, 2013).
It is important to treat the infection immediately, because many of these infections can be extremely harmful to newborns; for example, HSV encephalitis can result in brain damage and possibly death if left untreated for too long (Caserta, 2013b). Infections contracted during pregnancy may result in premature rupture of membranes as well as premature labor and preterm delivery (Martin, Fanaroff, & Walsh, 2006). However, if a neonatal infection is treated quickly, many infants recover normally without additional problems (Lee, 2013).
A previous case handled by the attorneys of Meyers Evans Lupetin & Unatin involved the negligence of a doctor who failed to diagnose HSV in a newborn. At first, obvious signs of the infection, though documented, were ignored, including a reddened eye with discharge. Two weeks later, the infant started experiencing seizures. After finally performing the appropriate tests, the NICU staff diagnosed the infant with an HSV infection and started administering acyclovir. However, the two week delay caused widespread brain damage that left this child with severe physical and cognitive impairment. In pursuit of justice and the opportunity to provide some comfort for this devastated family, the attorneys of Meyers Evans Lupetin & Unatin established numerous lapses in appropriate medical care on an individual and systemic level which led to the child’s injuries. Sadly, given his advanced brain injury, the young boy did not survive long enough to realize the intended dramatic benefit which would have been provided by the money which we obtained on his behalf.
Martin, R. J., Fanaroff, A. A., & Walsh, M. C. (2006). Fanaroff and Martin’s neonatal-perinatal medicine: Diseases of the fetus and infant (8th ed., Vol. 1). Philadelphia, PA: Mosby Elsevier.