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Infection in Newborn Babies

Newborn babies have weak immune systems. This is one reason why breastfeeding is so important: it provides the newborn baby with antibodies to help fight infection. As a result, breastfed infants have fewer infections than babies who are bottle fed.

When a newborn baby does develop an infection, it can become a great cause for concern. This is because newborn babies can get sick very fast. Luckily, they also respond very quickly to treatment, if the infection is caught in time. If a doctor suspects that a newborn baby has an infection, he will begin antibiotic treatment right away.

Causes of infection

Most infections in newborn babies are caused by bacteria, and some by viruses. As the bacteria or viruses multiply, the newborn baby can become ill very quickly. The sooner the infection is discovered and treated, the better the outcomes will be for the newborn baby.

Symptoms of infection

The symptoms of a beginning infection are listed below. It may be difficult at first to determine if the newborn baby has an infection, because healthy newborn babies can also have some of these symptoms even though there is no infection. In a newborn baby with an infection, these symptoms will continue and the baby needs to be checked by a doctor.

    • he is difficult to wake for feeds
    • he is listless or limp
    • he is refusing to breastfeed or drink from a bottle
    • he is having problems breathing
    • he is pale or flushed
    • crying inconsolably
    • he is having abnormal movements
    • he seems as if he is in pain
    • he has developed purple splotches on his skin, or another type of rash
    • he is vomiting or has diarrhea

    As the infection gets worse, a newborn may develop additional symptoms, including

    • difficulty breathing
    • bluish tinge around the mouth
    • pale or greyish skin
    • high body temperature above 38°C (101°F) taken rectally or 37.5°C (99.5°F) taken under the armpit
    • low body temperature (under 36.6°C (96°F)taken rectally) despite being wrapped in clothes and blankets

Diagnosis of infection

A number of tests can be used to diagnose the infection. However, test results usually take two to three days to come back, so in the meantime, the doctor will prescribe antibiotics for your newborn baby while he is waiting for the test results to confirm the diagnosis. For example, rapid breathing could be caused by infection, and any delay in treatment could result in the newborn baby becoming much more ill.

The following tests may be needed to diagnose infection in newborn babies:

  • Complete blood count: This is when a sample of your newborn baby’s blood is taken. The complete blood count (CBC) will determine the number of each type of blood cell.   Special attention is focused on the number of white blood cells (WBCs), as these can be abnormal in number when an infection is present. An abnormal number of WBCs often indicates that the newborn baby’s body is fighting some sort of infection. Results of the CBC can be obtained quite quickly.
  • Blood culture: The blood culture will determine if any bacteria can be grown in the blood. If bacteria grow in the culture, the baby has an infection in the bloodstream. The results of this test can take up to 24 hours and sometimes longer, which is why treatment is not delayed while waiting for the result.
  • Urine test: This is when a sample of your newborn baby’s urine is taken to determine its white cell count and sent away for culture.
  • Eye or skin swab: This is when pus or fluid from a possible site of infection, such as the eye or umbilical cord, is swabbed and sent away for analysis.
  • Chest X-ray: A baby needs a chest X-ray if pneumonia is suspected.
  • Spinal tap: A lumbar puncture is also called a spinal tap, and it is necessary if an infection of the lining of the brain, called meningitis, is suspected. Before doing a lumbar puncture, a numbing cream may first be applied to the area of the spine where the lumbar puncture will take place. Local anaesthetic is then used to numb the site of the lumbar puncture. A hollow needle is inserted between the bones, called the vertebrae, of the spine. A sample of the cerebrospinal fluid is withdrawn through the needle and tested for infection. This is not a comfortable procedure; however, sedation and pain relief are provided to reduce your baby’s discomfort. Meningitis is a serious infection and the diagnosis can only be confirmed by examination of the cerebrospinal fluid. If your baby requires a lumbar puncture, try to remind yourself that the procedure is necessary in order to make an accurate diagnosis and provide the best possible treatment for your baby.

Treatment of infections

If your newborn baby has an infection, she may be taken to the special care nursery of the hospital, where she will be placed on a warming bed or in an incubator to regulate her body temperature. She may be attached to a cardiorespiratory monitor to measure her heart rate and breathing. She may also need a monitor called a pulse oximeter to determine if there are appropriate levels of oxygen in her body.

If a bacterial infection is suspected, your newborn baby will be given antibiotics. As infections in the newborn baby can be very serious and require quick and effective antibiotic treatment, the antibiotics are given as an intravenous (IV) infusion.   The IV is a hollow tube that sits in a vein. The IV ensures that the right amount of antibiotic enters your baby’s blood. Antibiotics are not given to newborn babies by mouth because they are not absorbed very well from the stomach. Your baby’s doctor will monitor the amount of antibiotic in your baby’s bloodstream, to make sure that she is receiving the right dosage. The length of time that antibiotics are administered depends on the type of infection that is being treated. Treatment can range from seven to 21 days. If the test results are negative, the antibiotics will most likely be discontinued.

Viral infections do not respond to antibiotics. Therefore, if it turns out that your newborn baby has a viral infection, she will usually need to fight the infection without medication. Supportive care will be given. Antiviral drugs are available to treat specific viruses such as herpes or HIV.

In addition to antibiotics, your newborn baby may be given other supportive care. For example, she may need IV fluids to prevent dehydration, or if she is too sleepy to eat. She may also need a tube inserted into her nose or mouth to drip milk directly into her stomach. This is called a nasogastric or gavage tube. Some newborn babies need extra oxygen during this time, especially if they have pneumonia.

Andrew James, MBChB, MBI, FRACP, FRCPC