Signs and Symptoms
History
- Nonspecific history:
- “Not acting normal”
- Feeding poorly
- Irritable or lethargic
- General:
- Toxic appearing
- Altered mental status: Irritable or lethargic
- Apnea or bradycardia
- Mottled, ashen, cyanotic, or cool skin
Physical Exam
- Vital signs:
- Hyperthermia/hypothermia
- Tachypnea
- Tachycardia
- Prolonged capillary refill time
- Abdominal distention
- Jaundice
- Bruising or prolonged bleeding
- Sepsis syndrome in the neonate:
- Septic shock
- Hypoglycemia
- Seizures
- Disseminated intravascular coagulation (DIC)
- If untreated, cardiovascular collapse and death
Essential Workup
- Sepsis evaluation followed by empiric antibiotics and support
- Determine a source for the infection
- Identify metabolic abnormalities
Diagnostic Tests & Interpretation
Lab
- Bedside glucose determination
- CBC:
- WBCs elevated or suppressed
- Shift to the left
- Thrombocytopenia
- C-reactive protein (CRP)
- Urinalysis
- Cultures as soon as the diagnosis is entertained:
- Blood, CSF, catheterized or suprapubic urine, stool
- Lumbar puncture:
- May need to delay if hemodynamically unstable
- Cell count, protein, glucose, culture, Gram stain
- Serum glucose needed to exclude hypoglycemia
- Arterial blood gas and oximetry:
- Metabolic acidosis is common
- Electrolytes and calcium:
- DIC panel:
- Coagulopathy is a late complication
- Monitor PT, PTT, and fibrinogen-split products
Imaging
CXR to rule out pneumonia
Differential Diagnosis
- Heart disease:
- Hypoplastic left heart syndrome
- Myocarditis
- Metabolic disorders:
- Hypoglycemia
- Adrenal insufficiency (congenital adrenal hyperplasia)
- Organic acidoses
- Urea cycle disorders
- Intussusception
- Child abuse
- CNS:
- Intracranial hemorrhage
- Perinatal asphyxia
- Neonatal jaundice
- Hematologic emergencies:
- Neonatal purpura fulminans
- Severe anemia
- Methemoglobinemia
- Malignancy (congenital leukemia)