Infection: Sepsis, Meningitis, Encephalitis, Pneumonia and Birth Injury*

Meningitis is a dangerous infection of the membranes that surround the brain and spinal cord. Meningitis is caused by listeria and E. Coli, but it is most commonly caused by Group B Strep. Pregnant women should be tested for Group B Strep and prescribed antibiotics to prevent them from passing it on to the child. If a newborn has meningitis, it is formally diagnosed using a spinal tap and treated in the NICU. Typically, newborns with signs and symptoms of infection are treated prophylactically with antibiotics before the diagnosis is made.

Infections in newborns can be serious. Babies born with infections may become very sick and may require significant time in the hospital for recovery. Most babies recover without significant long-term damage when the appropriate diagnosis and treatment is timely. A delay or misdiagnosis can mean serious and permanent mental and physical damage to the child and can even be fatal.

Neonatal Infection

Some infections are contracted soon after birth when a newborn’s immune system is still immature and unable to fight infection. Many other infections are transmitted to the baby through the mother and the delivery process. Therefore, it is critical for maternal infection to be identified and promptly treated in order to protect the unborn child.
The types of infections vary. Babies can get viral infections such as herpes simplex virus, chickenpox (varicella virus), Rubella virus, or the hepatitis virus. They can also contract bacterial infections like Group B Streptococcus, Listeria, E. coli, or syphyalis. Or they can get a parasitic infection like Toxoplasmosis.

Medical Explanations

Symptoms, Diagnosis and Treatment of Neonatal Infection

Newborns that are infected will have symptoms. These may include:

  • Inactivity
  • Apnea
  • Respiratory problems
  • Decreased or elevated body temperature
  • Poor feedings
  • Irritability
  • Odd skin color
  • Low blood pressure
  • Seizures

Doctors will usually test fluid samples and run blood tests and cultures from the infant and often the mother to diagnose the infection. Treatment for most infections includes antibiotics or antiviral medications as well as supportive care (intravenous (IV) fluids, oxygen or a breathing machine, and other medicines).

There can be severe consequences if infection in a newborn is not timely diagnosed and properly treated. The infection can quickly spread and become a much more serious acute infection. Generalized infection or infection of the blood is called sepsis; infection that settles around the brain is meningitis; infection of the brain is called encephalitis; and infection of the lungs is pneumonia.


This is a serious infection that involves the spread of germs throughout the blood and tissues. The most common microorganisms associated with sepsis include Group B Streptococcus, E. coli, Listeria, C-negative Staphylococcus, and H. influenzae. Blood tests and sometimes a test of cerebrospinal fluid are necessary for diagnosis. If the tests are positive, antibiotics are prescribed and the baby is monitored very closely in the neonatal intensive care unit (NICU). The prognosis for properly treated newborns is good with little to no residual physical or mental problems. If untreated or not effectively treated the mortality rate may be as high as 50%. Pre-term infants with sepsis are noted to have higher rates of cognitive deficits, cerebral palsy, and other neurological disabilities.


This is inflammation of the membranes around the brain and spinal cord and is a very serious infection in newborns. Listeria and E. coli are common causes of meningitis in newborns. However, the most common source of meningitis in the United States is Group B Streptococcus. According to the U.S. Centers for Disease Control and Prevention, 10-30% of pregnant women carry Group B Strep which can potentially lead to neonatal meningitis. Pregnant women should be tested prenatally for Group B Strep so that the mother may be appropriately treated. Those that test positive should also receive antibiotics during delivery to avoid passing Group B Strep to their baby.

Diagnosis of meningitis in newborns is done through a spinal tap. Depending on the cause, antibiotics or antiviral medications are given. Intense supportive care in the neonatal intensive care unit (NICU) is required.


Encephalitis is an inflammation of the brain caused by a virus, most often herpes simplex virus (“genital herpes”). If a pregnant woman has the virus, she can pass it to her baby through the infected birth canal. A mother who experiences a first outbreak of the virus during the third trimester of pregnancy has a 33% chance of transmitting the virus to her baby. For a pregnant woman who has had herpes simplex for a while and experiences a recurrent outbreak of genital herpes, the risk of transmission is about 3%. About 80% of all women who are infected with the herpes simplex virus will have a recurrence during their pregnancy. Pregnant women previously infected have an average of about 3 recurrences during pregnancy.

To minimize the risk of transmission to the baby, pregnant women must be tested prenatally for the herpes simplex virus and treated appropriately. A pregnant woman with the virus should receive an antiviral medication such as acyclovir around 36 weeks and during labor.  Women experiencing active lesions around the time of delivery – whether it’s a primary outbreak or recurrent – must have a c-section to reduce the chances of transmission to the infant.

To diagnose encephalitis in infants, doctors will typically run blood tests, do a CT scan, MRI, an EEG, and sometimes a spinal tap. Herpes encephalitis is extremely dangerous to a newborn and so doctors will generally begin medication without waiting for confirmatory results. An IV of acyclovir is given to newborns with encephalitis for 2-3 weeks. The prognosis for infants with encephalitis depends on the severity of the case, strength of the newborn’s immune system, and the timing of the diagnosis and treatment. Those with mild cases may recover without any problems while more severe cases can result in lifelong mental and physical disabilities such as cerebral palsy, intellectual disability, and seizures.


This bacterial lung infection can cause pulmonary changes, destruction of bronchopulmonary tissue, respiratory distress, respiratory failure, and can develop into sepsis. Diagnosis is done through blood cultures, tracheal aspirate, chest x-ray, and pulse oximetry. Treatment includes initial broad-spectrum antibiotics changed to organism-specific drugs once identified.

If neonatal infection is not diagnosed and treated right away, it can lead to these and other very serious acute infections which can have devastating results. A child may be left with permanent seizures, cerebral palsy, blindness, cognitive impairments, deafness, developmental delays, speech delays, language delays, or even death.

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