Infections in Newborns
Newborns are at a high risk of infection because their immune systems are not developed enough to fight bacteria, viruses, and other pathogens as effectively as an adult or older child could. Infections can be transmitted from mother to baby during pregnancy or the birthing process, or an infant may become infected shortly after birth. Often, newborn infections can be prevented through the use of prophylactic antibiotics, a scheduled C-section, or by ensuring that vaginal delivery is not prolonged (because this increases a time period in which infants are particularly vulnerable to certain infections that ascend through the uterus). Newborns that become infected often need to spend time in a neonatal intensive care unit (NICU). If infant infections are not recognized and treated in a timely fashion, they can lead to serious brain injuries and cerebral palsy due to meningitis, encephalitis, and hypoxic-ischemic encephalopathy, and in some cases can even be fatal.
Most babies become infected while coming down the birth canal during delivery. This is called a “vertical” transmission. Occasionally, babies are infected before birth “in utero” or after birth. Infections acquired after birth are called “horizontal” transmission. Most neonatal infections are caused by bacteria. Infections can also be caused by viruses and much less commonly, fungi. In some cases, different categories of infections can result in similar outcomes. For example, sepsis – an infection of the bloodstream that can lead to brain damage and other permanent, negative outcomes – can be caused by many different pathogens.
Symptoms, Diagnosis, and Treatment of Neonatal Infection
Newborns that are infected may show the following symptoms:
- Respiratory problems
- Decreased or elevated body temperature
- Poor feedings
- Odd skin color
- Low blood pressure
Doctors will usually test fluid samples and run blood tests and cultures from the infant, and often the mother, to diagnose the infection. Treatment for most infections includes antibiotics or antiviral medications as well as supportive care (intravenous [IV] fluids, oxygen or a breathing machine, and other medicines).
There can be severe consequences if infection in a newborn is not quickly diagnosed and properly treated. The infection can rapidly spread and become a much more serious, acute infection. Generalized infection or infection of the blood is called sepsis; infection that settles around the brain is meningitis; infection of the brain is called encephalitis; and infection of the lungs is pneumonia.
This is a serious infection that involves the spread of germs throughout the blood and tissues. The most common microorganisms associated with sepsis include Group B Streptococcus, E. coli, Listeria, C-negative Staphylococcus, and H. influenzae. Blood tests and sometimes a test of cerebrospinal fluid are necessary for diagnosis. If the tests are positive, antibiotics are prescribed and the baby is monitored very closely in the neonatal intensive care unit (NICU). The prognosis for properly-treated newborns is very good, with little to no residual physical or mental problems. However, if untreated or not effectively treated, the mortality rate may be as high as 50%. Pre-term infants with sepsis are noted to have higher rates of cognitive deficits, cerebral palsy, and other neurological disabilities.
Meningitis is inflammation of the membranes around the brain and spinal cord. Neonatal meningitis is a very serious infection in newborns. Listeria and E. coli are common causes of meningitis in newborns. However, the most common source of meningitis in the United States is Group B Streptococcus. According to the U.S. Centers for Disease Control and Prevention, 10-30% of pregnant women carry Group B Strep, which can potentially lead to neonatal meningitis. Pregnant women should be tested prenatally for Group B Strep, so that they may be appropriately treated if they have it. Those that test positive should also receive antibiotics during delivery to avoid passing Group B Strep to their baby.
Diagnosis of meningitis in newborns is done through a spinal tap. Depending on the cause, antibiotics or antiviral medications are given. Supportive care in the neonatal intensive care unit (NICU) is required. Meningitis is a very serious threat to newborn health, so if it is suspected, medical professionals will often begin treatment before diagnosis is confirmed.
Encephalitis is an inflammation of the brain caused by a virus, most often herpes simplex virus (“genital herpes”). If a pregnant woman has the virus, she can pass it to her baby through the infected birth canal. A mother who experiences a first outbreak of the virus during the third trimester of pregnancy has a 33% chance of transmitting the virus to her baby. For a pregnant woman who has had herpes simplex for a while and experiences a recurrent outbreak of genital herpes, the risk of transmission is about 3%. About 80% of all women who are infected with the herpes simplex virus will have a recurrence during their pregnancy. Pregnant women previously infected have an average of about three recurrences during pregnancy.
To minimize the risk of transmission to the baby, pregnant women must be tested prenatally for the herpes simplex virus and treated appropriately. A pregnant woman with the virus should receive an antiviral medication such as acyclovir around 36 weeks and during labor. Women experiencing active lesions around the time of delivery – whether it’s a primary outbreak or recurrent – must have a C-section to reduce the chances of transmission to the infant.
To diagnose encephalitis in infants, doctors will typically run blood tests, do a CT scan, MRI, an EEG, and sometimes a spinal tap. Herpes encephalitis is extremely dangerous to a newborn, so doctors will generally begin medication without waiting for confirmatory results. An IV of acyclovir is given to newborns with encephalitis for 2-3 weeks. The prognosis for infants with encephalitis depends on the severity of the case, strength of the newborn’s immune system, and the timing of the diagnosis and treatment. Those with mild cases and those with timely treatment may recover without any problems, while more severe cases can result in lifelong mental and physical disabilities such as cerebral palsy, devlopmental disabilities, and seizures if not quickly treated.
This bacterial lung infection can cause pulmonary changes, destruction of bronchopulmonary tissue, respiratory distress, respiratory failure, and can develop into sepsis. Diagnosis is done through blood cultures, tracheal aspirate, chest x-ray, and pulse oximetry. Treatment includes initial broad-spectrum antibiotics, later changed to organism-specific drugs.
Legal Help for Neonatal Infection Cases | Detroit, Michigan Birth Injury Attorneys
If neonatal infection is not diagnosed and treated right away, it can lead to very serious acute infections, which can have devastating results. A child may be left with permanent seizures, cerebral palsy, blindness, cognitive impairments, deafness, developmental delays, speech delays and language disorders, or even death.
When a loved one suffers a preventable birth injury, it can feel impossible to understand and process the medical and legal aspects of the situation. Families are often left wondering how they will find the support, information, and resources necessary to provide for their birth-injured loved one. From our main office in Detroit, Michigan, the Reiter & Walsh, P.C. team helps families affected by birth injury diagnoses. Our clients have hailed from Michigan, Pennsylvania, Tennessee, Mississippi, Texas, Wisconsin, Ohio, Arkansas, Washington D.C., and many more parts of the U.S.
If your child was diagnosed with a birth injury from a mismanaged neonatal infection, we encourage you to reach out for a free case review:
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