Neonatal bacterial infection and sepsis: Case

This preterm infant at 3 weeks of age is at high risk for late-onset sepsis. Prematurity, very low birth weight, prolonged NICU stay, and a central venous catheter in situ for 12 days are the dominant risk factors. Coagulase-negative staphylococci account for nearly half of all late-onset sepsis episodes in very low birth weight infants in the NICHD Neonatal Research Network. [1]

Clinical findings

The presenting signs — increasing apnoea, temperature instability, and a raised CRP — are classic but non-specific features of late-onset sepsis in the preterm infant. The differential includes culture-negative clinical sepsis, catheter-related bloodstream infection, necrotising enterocolitis, and metabolic deterioration. A full septic workup is mandatory: blood culture from a peripheral site and from the central line, complete blood count, CRP, and urine culture by suprapubic aspiration or sterile catheterisation. A lumbar puncture is indicated if the infant is stable enough and meningitis is clinically suspected. [1]