Septic Shock in Babies
Septic shock occurs when a baby develops sepsis (a bloodstream infection), and the sepsis progresses first to severe sepsis and then to septic shock. Sepsis in a newborn is typically caused by an infection in the mother that is passed on to the baby. Septic shock is a medical emergency that causes multiple organ dysfunction as well as dysfunction with the heart and blood flow. Usually, the baby’s blood pressure becomes critically low, which means that not enough oxygen is circulating to crucial organs like the brain. If sepsis is quickly and properly treated, septic shock will not occur. If shock is not promptly recognized and treated, it can cause major problems like permanent brain damage, cerebral palsy, hypoxic-ischemic encephalopathy (HIE) or seizures.
Progression of Septic Shock in Babies
Newborns develop early-onset sepsis by contracting an infection from the mother during or occasionally before delivery. This can can happen in several ways, including:
- Transmission to the baby through the amniotic fluid
- Transmission from bacteria (such as Group B streptococcus (GBS) or E.coli) that is present in the mother’s genital tract (which the baby comes in contact with during delivery)
Once bacteria gain access to the bloodstream, there may be overwhelming infection throughout the baby’s body (septicemia) and/or the infection can become localized in the baby’s lungs (pneumonia) or in the brain (meningitis).
This severe infection in the baby’s body can cause:
- Systemic inflammation
- Problems with the immune system
- Circulatory system dysfunction
- Major organ problems
When sepsis progresses to septic shock, the baby may have severe heart and vascular problems like:
- Very low blood pressure
- Blood flow problems
- Decreased urine output
- Metabolic acidosis (acidic blood)
This means the baby has inadequate blood circulating to the tissues. This can cause organ damage, including permanent brain injury in the baby.
Septic Shock and Meningitis
When a baby has sepsis or septic shock, the infection may directly enter the central nervous system or cause meningitis (inflammation in the membranes surrounding the brain and spinal cord). Meningitis can cause serious health complications, including:
- Fluid build-up in the brain
- Increased pressure in the brain
- Brain abscesses (pus-filled pockets)
- Cerebral infarction (lack of blood flow to an area or areas of the brain)
When meningitis occurs, it must be treated as soon as possible to try and minimize the brain damage that can occur. Brain damage caused by meningitis can cause cerebral palsy, developmental delays, seizure disorders and learning disabilities.
Signs of Meningitis in a Baby
Signs of meningitis include:
- Failure to respond to antibiotic therapy
- Respiratory depression
- Bulging fontanelle (soft spot)
- Fast head growth
- Separation of parts of the skull (separation of cranial sutures
- Weakness on one side of the body
|Note: Doctors should promptly treat sepsis and septic shock in order to decrease the risk of meningitis. It cannot be emphasized enough that the key to preventing meningitis and septic shock in babies is prompt recognition and treatment of sepsis.|
How is Septic Shock Diagnosed in a Baby?
Septic shock in a baby is diagnosed when the baby has:
- Signs of inadequate tissue perfusion (blood flow to the tissues)
- Suspected or proven infection
- Two signs of systemic inflammatory response syndrome (SIRS), which is an inflammatory state affecting the whole body. Signs of SIRS include: fast heart rate, high or low body temperature, fast breathing, and markers for infection (such as an abnormal number of white blood cells or immature neutrophils).
What to Expect if Your Baby Has Septic Shock
The serious medical problems that occur when a baby is in shock can perpetuate each other and create additional problems. Babies with septic shock may have:
- A need for a breathing machine called a ventilator. This is especially likely if the baby has pneumonia and / or respiratory distress.
- Hypothermia (baby’s core body temperature is lower than normal)
- Very fast or very slow heart rate
- Cool extremities
- Very fast breathing, very slow breathing, or periods whereby breathing stops for 20 seconds or more (apnea)
- Low blood pressure
- Altered mental state (baby is irritable, anxious, lethargic, overly sleepy or apneic)
- Sunken eyes
- Decreased urine output
The Long-Term Outcomes of Septic Shock
Septic shock is the most common cause of neonatal death. Babies that survive may have permanent brain damage and cerebral palsy. However, if shock is recognized early and prompt treatment is given, the child can have a good outcome. Of course, prompt treatment of sepsis is key so that septic shock never develops.
Treating Septic Shock in Babies
When a baby is in septic shock, supportive care and antibiotic treatment are equally important.
Antibiotics for Septic Shock
Antibiotic treatment is of such critical importance that physicians should begin administering these drugs even if sepsis is suspected; doctors should not delay treatment while waiting for test results confirming sepsis.
Supportive Therapy for Septic Shock
The main goals of the numerous treatments given to babies who have septic shock are:
- Restoration of proper tissue perfusion
- Improvement of oxygenation (the delivery of oxygen to the baby’s tissues)
- Normalization of cellular metabolism (energy demand and consumption).
Supportive treatments may include:
|Possible Supportive Treatments for Septic Shock in Babies|
|Giving fluid therapy and using volume expansion drugs||Increase blood volume and blood pressure|
|Providing medications that affect blood vessels||Increase blood flow to vital organs|
|Provide oxygen therapy at 100% (initially)||Increase oxygen delivery to the tissues in the short term (tapered down as soon as possible to avoid oxygen toxicity)|
Babies with septic shock are at risk for hypoglycemia (low blood sugar) and hypocalcemia (low blood calcium). Both conditions must be promptly treated. If left untreated, both conditions can cause heart and brain problems.
It is critical that improvement in circulation, perfusion (blood flow and delivery of blood to tissues) and organ function occur within the first 6 hours of a baby going into septic shock, and this is the main goal of treatment.
How Long Will It Take My Baby to Recover From Septic Shock?
Once medical professionals have recognized the septic shock and resuscitated the baby (when blood pressure, heart rate and other cardiovascular issues are stabilized), the baby may need to be transferred to a hospital that has neonatal critical care specialists. Babies in septic shock need to be treated by specialized teams; it also is important that the team transporting the baby also have expertise in managing neonatal septic shock.
Recovery time from septic shock varies widely and is dependent upon many factors, including adequacy of organ function, blood pressure and perfusion. Lasting heart or lung problems can slow down recovery.
Since many babies with sepsis require help with breathing, it may be weeks before respiratory distress and pneumonia resolve enough to allow the baby to breathe on their own.
Some babies stay in the hospital for many weeks after septic shock. If the baby has brain damage like hypoxic-ischemic encephalopathy (HIE), meningitis or cerebral palsy, they may need frequent and regular visits to neurologists, therapists and other specialists.
How Does Septic Shock Cause Cerebral Palsy, HIE and Seizures?
Septic shock can cause hypoxic-ischemic encephalopathy (HIE), seizures and cerebral palsy in numerous ways. The cardiovascular effects of shock can cause significant oxygen deprivation in the baby’s brain, which can cause permanent brain damage. Shock can also cause heart, liver and kidney dysfunction, which can also lead to brain damage. If the baby has significant breathing problems, such as pneumonia and/or respiratory distress, s/he is at risk of suffering from a lack of oxygen to the brain as well as overventilation injuries, which can cause cerebral palsy. Other issues caused by septic shock, such as metabolic problems, hypoglycemia, hypocalcemia and other electrolyte problems can either directly or indirectly affect the brain.
Trusted Legal Help for Septic Shock and Meningitis in Babies
Sepsis, septic shock, meningitis, HIE, seizure disorders and cerebral palsy are very sad conditions to see in a baby. At Reiter & Walsh ABC Law Centers, we focus exclusively on birth injury cases, taking the time to get to know your family and fully understand your child’s needs. With over 100 joint years of birth trauma experience, helping children is our sole focus.
To find out if you have a case, contact us. We’ve helped clients in Michigan, Ohio, Washington, D.C., Pennsylvania and throughout the nation. We have numerous multi-million dollar verdicts and settlements that attest to our success and no fees are ever paid to our firm until we win your case.
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