Neonatal Infections

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The signs of neonatal sepsis are often subtle: they may by poorly localized and not specifically indicative of infection, so may therefore be mimicked by many non-infectious conditions. Untreated sepsis results in rapid deterioration which is often irreversible. When sepsis is suspected, therefore, the rule in neonatal medicine is to treat early, with or without the benefits of ancillary laboratory tests, and before the results of cultures are available. This appropriate but empirical approach to the management of suspected sepsis generates many problems. The neonatologist has to decide whether invasive investigations, such as lumbar puncture and suprapubic aspiration of urine, should be performed on all babies before starting antibiotics; which babies should be treated, and the relative importance of laboratory and clinical criteria in deciding who to treat; whether to prescribe antibiotics according to a general antiobotic policy or based on the circumstantial evidence provided by surveillance cultures; and how long to continue antibiotics if subsequent cultures are negative. Because antibiotics are frequently prescribed in neonatal units, often for long periods, selection of organisms resistant to one or many antibiotics is a perennial problem. The incidence of fungal infections is increasing, particularly in infants of low birth-weight. The intensive care environment and the extreme susceptibility of the babies who are relatively immunocompromised and justifiably subjected to invasive procedures make hospital-acquired infections a major consideration. The neonatologist may be consulted by obstetric colleagues about the timing of preterm delivery, the relative importance of infection and prematurity in preterm prolonged rupture of the membranes and the possible benefits of giving antibiotics to the mother to prevent neonatal infection. This book is not intended as a comprehensive reference work on neonatal infections. There are medical textbooks in which specific problems with infection are dealt with in an exhaustive manner. The intention in this work is to offer the personal view of the of the authors of the principles and thinking behind the management of neonatal infections, caused by bacteria, viruses and fungi, both in terms of individual babies and in the wider context of all babies in the newborn nursery.