Neonatal Infections

The vast majority of newborns enter the world healthy. But sometimes, infants develop conditions that require medical tests and treatment.

Newborns are particularly susceptible to certain diseases, much more so than older children and adults. Their new immune systems aren't adequately developed to fight the bacteria, viruses, and parasites that cause these infections.

As a result, when newborns get sick, they may need to spend time in the hospital — or even the neonatal intensive care unit (NICU) — to recover. Although it can be frightening to see your baby hospitalized, a hospital stay is often the best way back to good health for a sick newborn.

Signs to Look for

Many infections cause similar symptoms. Call your child's doctor or seek emergency medical care if your new baby shows any of these possible signs of infection:

• poor feeding
• breathing difficulty
• listlessness
• decreased or elevated temperature
• unusual skin rash or change in skin color
• persistent crying
• unusual irritability

A marked change in a baby's behavior, such as suddenly sleeping all the time or not sleeping much at all, can also be an indication that something isn't right.

These signs are of even greater concern if the baby is less than 2 months old. To make ensure good health, have your baby checked by a doctor right away if you suspect a problem.

Group B Streptococcal Disease (GBS)

What is it?

Group B streptococcus is a common type of bacterium that can cause a variety of infections in newborns. Some of the most common are sepsis, pneumonia, and meningitis. Babies usually get the bacteria from their mothers during birth — many pregnant women carry these bacteria in the rectum or vagina, where they can easily pass to the newborn if the mother hasn’t been treated with antibiotics.

Babies with GBS often show symptoms of infection within the first week of life, although some develop symptoms weeks or months later. Depending on the infection (pneumonia or sepsis, for example), the symptoms might include trouble breathing or feeding, a high temperature, listlessness, or unusual crankiness.

How is it diagnosed and treated?

To diagnose GBS, doctors run blood tests and take cultures of blood, urine, and, if necessary, cerebrospinal fluid to look for bacteria. Doctors use needles to obtain a blood sample and a spinal needle to do a lumbar puncture for the cerebrospinal fluid. The urine is usually obtained by a catheter inserted into the urethra. Infections caused by GBS are treated with antibiotics, as well as careful care and monitoring in the hospital.

Listeriosis

What is it?

Infection with Listeria monocytogenes bacteria can lead to diseases such as pneumonia, sepsis, and meningitis in newborns. Most people encounter the bacteria by eating contaminated food because the bacteria are found in soil and water and can end up on fruits and vegetables, as well as in foods that come from animals, such as meat and dairy products. Food that isn't properly cleaned, pasteurized, or cooked may give someone listeriosis.

Babies can acquire bacteria from their mothers if the mother contracts listeriosis while pregnant. In severe cases, listeriosis may lead to premature delivery or even stillbirth. Babies born with listeriosis may show signs of infection similar to those of GBS.

How is it diagnosed and treated?

A blood or spinal fluid culture can reveal the presence of the bacteria, and infected babies will be treated with antibiotics in the hospital.

E. Coli

What is it?

Escherichia coli (E. coli) is another bacterial culprit behind some common neonatal infections, and can lead to urinary tract infections, sepsis, meningitis, and pneumonia. Everyone carries E. coli in their bodies, and babies can become infected during childbirth, when they pass through the birth canal, or by coming into contact with the bacteria in the hospital or at home. Most newborns who become ill from E. coli infection have particularly fragile immune systems that make them particularly vulnerable to getting sick.

As with other bacterial infections, the symptoms will depend on the kind of infection that develops from E. coli, but fever, unusual fussiness, listlessness, or lack of interest in feeding are common.

How is it diagnosed and treated?

Doctors diagnose E. coli infection by culturing blood, urine, or cerebrospinal fluid and treat the infection with antibiotics.

Meningitis

What is it?

Meningitis is an inflammation of the membranes surrounding the brain and spinal cord. It can be caused by viruses, fungi, and bacteria, including Listeria, GBS, and E. coli. Newborns can pick up one of these pathogens during birth or from their surroundings, particularly if they have weakened immune systems that would make them more susceptible.

Symptoms of infection in newborns aren't very specific and may include persistent crying, irritability, sleeping more than usual, lethargy, refusing to take the breast or bottle, low or unstable body temperature, jaundice, pallor, breathing problems, rashes, vomiting, or diarrhea. As the disease progresses, babies' fontanels, or soft spots, may begin to bulge.

How is it diagnosed and treated?

Meningitis, particularly bacterial meningitis, is a serious infection in newborns. If it is suspected, a doctor will do a lumbar puncture (also known as a spinal tap), inserting a needle into the spine to withdraw a sample of cerebrospinal fluid.

Treatment of meningitis depends on what caused it. Infants with bacterial and fungal meningitis receive antibiotics, while viral meningitis may be treated with antiviral medication. All infants with meningitis usually spend time in the hospital for monitoring and intense supportive care.

Sepsis

What is it?

Sepsis is a serious infection that involves the spread of germs throughout the body's blood and tissues. It can be caused by viruses, fungi, parasites, or bacteria. Some of these infectious agents are acquired during birth, while others are picked up from the environment. As with meningitis, the symptoms of sepsis are not specific and vary from child to child. A lower heart rate, breathing problems, jaundice, trouble feeding, low or unstable body temperature, lethargy, or extreme fussiness can all be signs of an infection.

How is it diagnosed and treated?

To diagnose or rule out sepsis, doctors draw blood and sometimes examine cerebrospinal fluid and other body fluids to look for bacteria or other pathogens. They typically look for sepsis and meningitis in the same work-up. Once a positive diagnosis is made, the child will receive a course of antibiotics during a stay in the hospital.

Conjunctivitis

What is it?

Some newborns develop an inflammation of the eye's covering membranes (or conjunctiva), known as conjunctivitis or pinkeye, which appears as redness and swelling in the eye, usually accompanied by a discharge. Both bacterial and viral infections can cause conjunctivitis in newborns.

How is it diagnosed and treated?

A thorough physical examination and lab tests on a sample of discharge from the eye will help the doctor determine the cause of the infection. Antibiotics, eye drops, or ointment may used to treat conjunctivitis in a newborn. The infection can be very contagious, so the doctor may also suggest that other children in the family limit contact with the baby. If a more serious type of conjunctivitis is suspected, hospitalization may be necessary.

Candidiasis

What is it?

An overgrowth of the common yeast candida, found on everyone's body, leads to the fungal infection candidiasis. In newborns, it usually shows up as diaper rash, but babies can also develop oral thrush in the mouth and throat. It causes cracks in the corners of the mouth and white patches on the tongue, palate, lips, and insides of the cheeks. Newborns who get thrush have often picked up the fungus from the mother's vagina during delivery or during breastfeeding.

How is it diagnosed and treated?

Sometimes the doctor will take a swab of one of the patches in the mouth and examine it for signs of the fungus. In most cases, this isn't necessary and treatment is started based on the appearance of the mouth lesions alone. Thrush can be treated with liquid antifungal medicine.

Congenital Infections

What are they?

Many infections that affect newborns are transmitted from mother to infant, either during pregnancy or delivery. Because the baby is born with them, they're known as congenital infections. They are most often caused by viruses and parasites.

Congenital infections include: HIV (which causes AIDS); rubella (German measles); chickenpox; syphilis; herpes; toxoplasmosis; and cytomegalovirus (CMV), the most common congenital infection and the leading cause of congenital hearing loss. Several of these infections, such as GBS infection and listeriosis, can be acquired either from the mother or later from the newborn's environment.

It's more likely that babies will be born with an infection if their mothers become infected for the first time with a particular germ while pregnant. However, transmission to the baby doesn't always occur, so many babies born to mothers with these infections don't have the infection themselves. Other newborns may not initially show signs of disease, but may later exhibit its effects.

The risk these infections pose to an infant often depends on when the mother is exposed to the germ. With many infections, such as rubella and toxoplasmosis, the risk is greatest in the first trimester. If the mother becomes infected then, it can cause serious problems such as heart disease, brain damage, deafness, visual impairment, or even miscarriage. Infection later in the pregnancy may lead to less severe effects on the fetus but can still cause problems with the infant's growth or development.

Some early signs of a possible congenital infection include: a large or small head, small body size, seizures, problems with the eyes, skin rashes, jaundice, enlarged abdominal organs, and a heart murmur.

How are they diagnosed and treated?

If a congenital infection is suspected, a doctor will run blood tests and cultures of blood and other fluids from the infant, and sometimes the mother, to try to make a diagnosis. Treatment often includes the antiviral or antibiotic medications that are used to treat the diseases in older patients, as well as intense supportive care while the baby's in the hospital. Congenital infections also call for close medical follow-up to watch for any effects of the disease that may develop as the infant grows.

Complications of Neonatal Infections

Neonatal infections that aren't treated promptly or that spread can have serious consequences. Because babies' bodies and organs are undergoing rapid development, any interruption in that process can lead to complications, including growth, developmental, neurological, cardiac, respiratory, and sensory problems. In some severe cases, neonatal infections can even be fatal.

With their fragile new immune systems, babies aren't well equipped to deal with infection. Premature or otherwise immunocompromised babies are at an even greater risk of developing a critical disease from a bacterium or virus that might cause a simple illness in an older child. An early diagnosis, swift treatment, and close monitoring and care give a baby the best chance of overcoming the infection.

Can Neonatal Infections Be Prevented?

If a pregnant woman is diagnosed with one of these infections, or if she is considered at risk of infection, preventive measures can lower the probability that she will pass it to her baby. Because many infections can be treated with medicine given to the mother while she's pregnant, maternal testing is extremely useful.

In many cases, a quick blood or fluid test can determine if a pregnant woman should receive treatment. For a woman with listeriosis, a course of antibiotics usually prevents transmission of the bacterium to the fetus. Women who are HIV positive are advised to take antiretroviral medication during pregnancy to lower the risk that their babies will contract HIV infection.

Other neonatal infections are best prevented through steps that keep expectant mothers from developing the infection in the first place.

Women can help protect themselves and their unborn babies by:

• making sure they've been immunized against rubella and chickenpox infection before trying to become pregnant

• thoroughly washing and cooking food, regularly washing hands (particularly before and after preparing food, after using the toilet, and after coming into contact with bodily fluids and waste), and avoiding all contact with cat and other animal feces to lower the risk of contracting bacteria and parasites that lead to infections such as listeriosis and toxoplasmosis

• practicing safe sex to avoid sexually transmitted diseases (STDs) that can lead to congenital infections

Some preventive measures are routine parts of pregnancy and delivery. Many doctors recommend that an expectant mother have a simple swab test late in pregnancy to check whether she's carrying GBS. If she is, she will receive intravenous (IV) antibiotics during delivery to lower the risk of transmitting the bacteria to her baby. Doctors also routinely put antibiotic drops or ointment in newborns' eyes to prevent conjunctivitis caused by gonorrhea bacteria.