Which medical therapies are used in the treatment of neonatal sepsis?

Updated: Jun 13, 2019
  • Author: Nathan S Gollehon, MD, FAAP; Chief Editor: Muhammad Aslam, MD  more...
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Answer

A neonate with sepsis may require treatment aimed at the overwhelming systemic effects of the disease. Cardiopulmonary support and intravenous (IV) nutrition may be required during the acute phase of the illness until the infant’s condition stabilizes. Monitoring of blood pressure, vital signs, hematocrit, platelet countss, and coagulation profile is vital. Not uncommonly, blood product transfusion, including packed red blood cells (PRBCs), platelets, and fresh frozen plasma (FFP), is indicated.

An infant with temperature instability needs thermoregulatory support with a radiant warmer or incubator. Once the infant is stable from a cardiopulmonary standpoint, parental contact is important.

Central line or peripherally inserted central catheter placement may be necessary in infants who require prolonged IV antimicrobial therapy for sepsis if peripheral IV access cannot be maintained. If an abscess is present, surgical drainage may be necessary as IV antibiotic therapy cannot adequately penetrate an abscess, and antibiotic treatment alone is often ineffective.

The infant may require transfer to a level III or IV perinatal center, especially if he or she requires cardiopulmonary support, parenteral nutrition, or prolonged IV access. The multidisciplinary services available at larger centers may be necessary if the neonate’s condition is acutely compromised.

Additional therapies have been investigated for the treatment of neonatal sepsis, including granulocyte transfusion, IV immune globulin (IVIg) infusion, exchange transfusion, plasmapheresis, and the use of recombinant cytokines. However, no substantial clinical trials have shown these treatments to be  beneficial.


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