Preface

Neonatal bacterial infection and sepsis are clinical syndromes characterized by systemic signs of infection associated with bacteraemia within the first month of life. There are two patterns of disease with different spectrums of causative agents, earlyand late-onset sepsis. Neonatal sepsis still remains a significant cause of morbidity and mortality in the newborn, particularly in preterm, low birth weight infants [Stoll and Hansen 2003]. Despite advances in neonatal care, overall case-fatality rates from sepsis range from 3% to as high as 50% [Palazzi 2001]. Clinical signs of bacterial infection are vague and non-specific, and up to now there exists no easily available, reliable marker of infection despite a large bulk of studies focussing on inflammatory indices in neonatology.

Bacterial pathogens that cause neonatal infections include Group-B-Streptococci (GBS), Escherichia coli, Haemophilus influenzae, Enterococci, Listeria monozytogenes, Streptococcus viridans, Streptococcus pneumoniae, and Staphylococcus aureus as the most common ones for early-onset infections and coagulase-negative Staphylococci (CONS), E.coli, Enterococci, Klebsiella pneumoniae, Staphylococcus aureus, and Streptococcus viridans for late-onset infections. The identity of each may be suggested by timing of infection, presentation of signs and symptoms, and response to empirically prescribed antibiotics. For all organisms, successful management requires thorough, thoughtful assessment of risk factors, complete and careful clinical and laboratory studies, and prompt initiation of antibiotics and supportive treatment.

Every neonatologist is faced with the uncertainty of under- or over- diagnosing bacterial infection, and positive blood cultures are not the "philosopher´s stone" per se. As a result many neonates and especially those born preterm receive empiric antibiotic therapy, and the longer they are treated the more resistant pathogens develop in case of unconfirmed infection. If the clinical picture combined with a negative culture result allows justification of the neonate as being not infected antibiotics should be terminated as early as possible.

In this book three topics will be discussed: clinical presentation including a general approach to "sepsis neonatorum" and two distinct diagnoses – pneumonia and

#### VIII Preface

osteomyelitis – diagnostic approaches including C-reactive protein and the immature myeloid information, and prevention and treatment of bacterial infection with immunoglobulins.

#### **Bernhard Resch, MD**

Research Unit for Neonatal Infectious Diseases and Epidemiology, Medical University of Graz, Austria Division of Neonatology, Department of Pediatrics, Graz, Austria

VIII Preface

immunoglobulins.

osteomyelitis – diagnostic approaches including C-reactive protein and the immature myeloid information, and prevention and treatment of bacterial infection with

Research Unit for Neonatal Infectious Diseases and Epidemiology,

Division of Neonatology, Department of Pediatrics, Graz,

**Bernhard Resch, MD**

Austria

Medical University of Graz, Austria

**Section 1** 

**Clinical Presentation** 

**Section 1** 

**Clinical Presentation** 

**Chapter 1** 

© 2013 Nemsadze, licensee InTech. This is an open access chapter distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

© 2013 Nemsadze, licensee InTech. This is a paper distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Sepsis has been a burden to mankind for millions of years and will continue to plague man as long as microorganisms exist here on earth. Only recently the medical community has started celebrating the World Sepsis Day (WSD) which was established in 2012, yet a decade before, at the end of the 20th century the Anti-Sepsis Center was founded in

Research shows that early recognition and intervention saves lives. To achieve this improvement requires a partnership between the public, parents, and healthcare professions. Sepsis is a common pediatric problem. Severe sepsis and septic shock are among the leading causes of death in infants and have an overall pediatric mortality rate of 8-10%. Definitive diagnosis requires clinical identification of infection in a patient who also meets the clinical criteria for the Systemic Inflammatory Response Syndrome

In the given chapter, early recognition, diagnostic criteria, treatment and prevention of

Neonatal Sepsis – is a clinical syndrome which is a general reaction to infection. Neonatal sepsis is characterized by systemic inflammation and general damage of tissues. Clinical definition is based on existing infection and systemic inflammatory response. Neonatal sepsis is diagnosed on the basis of clinical or microbiological data. Neonatal sepsis is an irreversible process which may cause mortality in cases of untimely detection and

**Early Detection and Prevention** 

Additional information is available at the end of the chapter

**of Neonatal Sepsis** 

Ketevan Nemsadze

http://dx.doi.org/10.5772/56121

**1. Introduction** 

Georgia. [1]

(SIRS). [2]

**2. Definition** 

treatment. [3]

neonatal sepsis are described.
