The younger and smaller the baby is, the more risk she has of developing sepsis.  Some of the risk factors for and causes of neonatal sepsis, meningitis and resultant seizures and cerebral palsy include the following:

• Traumatic delivery
• Group b streptococcus (GBS), Escherichia coli (E coli), herpes simplex virus (HSV)
• A lack of oxygen to the baby’s brain shortly before or during delivery (hypoxia / hypoxic ischemic encephalopathy (HIE))
• Maternal infection
• Psuedomonas, Klebsiella and Enterobacter species and Staphylococcus infections (Staph infections)
• The baby is a very low birth weight (VLBW) baby
• Urinary tract abnormalities in the mother
• The mother has a genetic disorder called galactosemia, which means she has difficulty breaking down simple sugars, such as glucose, lactose and galactose
• Premature rupture of the membranes (PROM)
• Premature / preterm birth

Sepsis must be diagnosed and treated very quickly because a delay in treatment may worsen the outcome for the baby.  Sepsis can not only cause permanent brain injury and cerebral palsy, but it is also a significant cause of death in babies, especially those that are premature and / or have a low birth weight.  In fact, the potential consequences of neonatal sepsis are so severe that researchers recommend that clinicians have a very low threshold for treating potential sepsis in a baby.  This means that in most cases, even suspected sepsis should be treated.

A baby may have sepsis if she:

• has seizures and / or jaundice;
• has breathing problems and respiratory distress that range from mildly fast breathing to respiratory failure;
• is on a breathing machine (ventilator) and needs more and more help from the vent;
• has apnea (periods in which she stops breathing for 20 seconds or more), and the apnea is increasing;
• has a slow heart rate (bradycardia). Bradycardia usually occurs in the later stages of sepsis;
• won’t tolerate feeding;
• has temperature instability and / or an increase in her heart rate (tachycardia);
• has a low blood pressure or evidence of poor blood flow in her body (poor perfusion);
• her extremities are cool and / or she looks bluish;
• has neurological changes such as irritability, lethargy and non-responsiveness;
• is not producing a lot of urine;
• is lethargic or hypotonic (floppy).

Research shows that on the first day of sepsis, most infants have new onset of apnea or a slow heart rate (bradycardia).  One study found that the most common signs of neonatal sepsis were apnea, hypoxia (baby suffering from a lack of oxygen), lethargy and gastric problems.

Neonatal sepsis is considered severe when the baby has heart, blood flow and blood pressure problems (cardiovascular problems), sudden onset respiratory distress syndrome (RDS), or dysfunction in two or more organ systems, called multi-organ failure.  In babies with severe sepsis, there is inflammation in the baby’s body that can cause a lot of damage.  Inflammation caused by sepsis causes the body to produce a cascade of biochemical events that can be very harmful to almost all the baby’s organs, including the brain and lungs.  Multi-organ dysfunction caused by sepsis is called systemic inflammatory response syndrome (SIRS).

Sepsis can cause the baby to go into shock, which means her blood flow and blood pressure are severely hindered.  This happens because sepsis can cause the blood to move out of the blood vessels and into a space next to the vessels, which means the blood is then not useful for important functions, such as oxygen, glucose and nutrient transport.  Low blood pressure and poor perfusion can cause very serious heart problems.  Septic shock can cause a severe lack of blood flow to the baby’s brain, which can cause brain injury and cerebral palsy – even when there is no meningitis.  Thus, in addition to antibiotic treatment for sepsis, which is discussed later, doctors must give fluid therapy when a baby is in shock to increase the baby’s blood pressure and blood volume.  Volume expansion therapy includes crystalloids (solutions of mineral salts or other water-soluble molecules) or colloids (such as blood) to help improve circulation, blood return to the heart, and the amount of blood the heart pumps out to the body.  Failure to quickly treat shock can not only cause cerebral palsy, but it can cause death.

When a baby has sepsis and the infection directly enters the central nervous system or causes inflammation in the brain, the baby may develop meningitis, which is inflammation of the membranes that surround the brain and spinal cord.  Meningitis can cause fluid build-up in the brain (edema), increased pressure in the brain (increased intracranial pressure), brain abscesses (pus-filled pockets), hydrocephalus and cerebral infarction and stroke.  These conditions are extremely damaging to the brain.  Doctors should promptly treat sepsis in order to decrease the chance of meningitis.

Signs of meningitis include a failure to respond to antibiotic therapy, bradycardia, respiratory depression, bulging fontanelle (soft spot), fast head growth, separation of parts of the skull (separation of cranial sutures), weakness on one side of the body, and seizures.  When meningitis occurs, it must be treated as soon as possible to try and minimize the brain damage that can occur.  Brain damage caused by meningitis can cause cerebral palsy, developmental delays, seizure disorders and learning disabilities.