Sepsis in premature infants

What it is

From: Orphanet

A rare systemic condition affecting neonates born at less than 37 weeks gestational age and characterized by life-threatening organ dysfunction caused by a dysregulated host response to an infection, which may have been acquired shortly before or during birth (resulting in early-onset neonatal sepsis during the first 72 hours of life), or after birth (leading to late-onset neonatal sepsis between 72 hours and three months). Prematurity constitutes one of the primary risk factors for neonatal sepsis. The clinical picture may develop gradually with signs and symptoms like irritability, lethargy, or poor feeding, or progress rapidly to respiratory distress, fever, hypothermia, hypotension, shock, and multiple organ failure.

Reported clinical features and what the terms mean

The following findings are associated with this condition in Orphanet. They are not a checklist for diagnosing yourself, and they do not all occur in every affected person. Some are examination, imaging or laboratory findings that cannot be recognised at home.

The frequency labels describe how often a finding was reported among people with the condition in the source. They do not give the chance that a person with that symptom has the condition. Definitions below reproduce HPO terminology; they explain the term, not the likely severity in an individual.

Abnormality of immune system physiology · Very frequent (99-80%)

A functional abnormality of the immune system.

Neonatal sepsis · Very frequent (99-80%)

Systemic inflammatory response to infection in newborn babies.

Premature birth · Very frequent (99-80%)

The birth of a baby of less than 37 weeks of gestational age.

Small for gestational age · Very frequent (99-80%)

Smaller than normal size according to sex and gestational age related norms, defined as a weight below the 10th percentile for the gestational age.

Tachycardia · Very frequent (99-80%)

A rapid heartrate that exceeds the range of the normal resting heartrate for age.

Abdominal distention · Frequent (79-30%)

Distention of the abdomen.

Abnormal mucociliary clearance · Frequent (79-30%)

An anomaly in the system of mucociliary transport, which functions to transport the mucous layer lining the respiratory epithelium by ciliary beating.

Caesarian section · Frequent (79-30%)

Delivery of a fetus through surgical incisions made through the abdominal wall (laparotomy) and the uterine wall (hysterotomy).

Decreased body weight · Frequent (79-30%)

Abnormally low body weight.

Decreased total neutrophil count · Frequent (79-30%)

Abnormal decrease of absolute number of neutrophils in the blood, per microlitre, compared to a reference range for a given sex and age-group.

Dyspnea · Frequent (79-30%)

Difficult or labored breathing. Dyspnea is a subjective feeling only the patient can rate, e.g., on a Borg scale.

Elevated circulating C-reactive protein concentration · Frequent (79-30%)

The concentration of C-reactive protein in the blood circulation is above the upper limit of normal.

Fever · Frequent (79-30%)

Body temperature elevated above the normal range.

Functional abnormality of the gastrointestinal tract · Frequent (79-30%)

Abnormal functionality of the gastrointestinal tract.

Other findings in the same source

From: Orphanet

Additional reported features include Gastrointestinal dysmotility (Frequent (79-30%)); Hypothermia (Frequent (79-30%)); Increased circulating interleukin 6 concentration (Frequent (79-30%)); Increased total leukocyte count (Frequent (79-30%)); Metabolic acidosis (Frequent (79-30%)); Neonatal hypotonia (Frequent (79-30%)); Pallor (Frequent (79-30%)); Severe infection (Frequent (79-30%)); Abnormal bleeding (Occasional (29-5%)); Abnormal respiratory system physiology (Occasional (29-5%)). This is a selected summary, not a complete description of the condition.

When it may begin

From: Orphanet

Neonatal

Inheritance in the source

From: Orphanet

Not applicable

Frequency and the population described

From: Orphanet

Point prevalence: 1-5 / 10 000; Europe; Value and class.

Which doctor should you see?

The suggested department for discussing Sepsis in premature infants is Rheumatology, with a rheumatologist as the relevant type of clinician. General physician / Family Medicine; paediatrician for children. Referral depends on symptoms.

This is an editorial referral starting point. The appropriate clinic depends on the person’s age, symptoms, previous diagnosis and local services. The first clinician can decide whether another specialty or a team is needed; a department label does not confirm the diagnosis.

How to prepare for an assessment

Bring a short timeline of the main symptoms: when they first appeared, whether they are constant or episodic, what seems to change them, and how they affect daily activities. Include previous reports, discharge summaries, current medicines and supplements, allergies, and any relevant family history. A dated record is more useful than trying to match every feature in an online article.

Ask the clinician what is already established and what remains uncertain. If a test is suggested, ask what question it answers, what its limitations are and how the result would change the next step. The information here is not an instruction to arrange every possible test. In children, bring growth, developmental and school information if it is relevant to the concern.

• Are the findings inflammatory, structural or due to another mechanism?
• Is there evidence that other organs need assessment?
• How will function and any treatment-related risks be monitored?

Treatment discussions and follow-up

The material gathered for this draft does not provide a complete condition-specific treatment pathway for Sepsis in premature infants. That gap does not mean that treatment is unavailable. A clinician needs to establish the diagnosis and review current guidance before recommending medicines, procedures, rehabilitation or other support.

Before leaving the appointment, clarify the next review date, who will communicate results, and whom to contact if the situation changes. Discuss difficulties with sleep, work, school, mobility, eating or emotional wellbeing when these are relevant. Practical support may require coordination between the treating clinician and other services.

The collected references do not establish a complete prevention or long-term outlook section for this entry. Missing information should not be interpreted as proof that prevention is impossible or that a particular outcome is inevitable. Ask what is known for the exact subtype, stage and personal circumstances, and which uncertainties remain.

When to seek emergency help

Severe breathing difficulty, collapse, new stroke-like symptoms, a seizure that is prolonged or repeated without recovery, uncontrolled major bleeding, or an immediate risk of self-harm require emergency help. In India, call 112 or reach the nearest emergency department. This is a general, non-exhaustive warning list; it is not a condition-specific triage tool.