Are there any major risk factors for early-onset sepsis? Major risk factors are preterm birth, low birthweight (risk factor most associated with early-onset sepsis), rupture of membranes (ROM) >18 hours, maternal colonization with GBS (if inadequate intrapartum therapy), or maternal chorioamnionitis (defined as maternal fever ≥38.0°C [≥100.4°F] and a minimum of 2 of the following: maternal white blood cell [WBC] count >15,000 mm3, maternal tachycardia [>100 beats/min], fetal tachycardia [>160 beats/min], uterine tenderness, foul odor of the amniotic fluid).
Are there any other maternal risk factors for sepsis in the infant? Other risk factors include African race, maternal malnutrition, recently acquired sexually transmitted disease/sexually transmitted infection (STD/STI), maternal age <20 years, low socioeconomic status, and asymptomatic maternal bacteriuria. Maternal history of a previous infant with GBS infection also increases the risk of sepsis.
Are there other intrapartum risk factors for sepsis in the infant? These include maternal infection, any untreated or incompletely treated infection of the mother, and maternal fever without identifiable cause. The use of fetal scalp electrodes in the intrapartum period increases the risk of infection in the infant. Meconium-stained amniotic fluid and traumatic delivery are also risk factors.
Are there any other neonatal risk factors involved? Other risk factors include male sex, low Apgar scores, severe depression at birth with intubation and resuscitation, perinatal asphyxia, twin birth, and presence of the metabolic disorder galactosemia (increased risk of gram-negative sepsis).
How long before delivery did the membranes rupture? ROM that occurs >18 hours before birth is associated with an increased incidence of infection in the neonate.
Was the infant monitored during labor? Fetal tachycardia (>160 beats/min), especially sustained, and decelerations (usually late) can be associated with neonatal infection. Prolonged duration of intrauterine monitoring is a risk factor for early-onset group B streptococcal disease.
Did the mother have a cerclage for cervical incompetence? Cerclage increases the risk of infection in the infant. Preterm PROM occurs in 38% of women with cerclage in place. Retention of cerclage for more than 24 hours after PROM was found to prolong pregnancy for more than 48 hours, but also to increase maternal chorioamnionitis and neonatal mortality from sepsis.
Are signs of sepsis present in the infant? Signs of sepsis are nonspecific and can include apnea and bradycardia, temperature instability (hypothermia or hyperthermia), feeding intolerance, tachypnea, jaundice, cyanosis, poor peripheral perfusion, hypoglycemia, lethargy, poor sucking reflex, increased gastric aspirates, and irritability. Other signs include tachycardia, shock, vomiting, seizures, abnormal rash, abdominal distention, and hepatomegaly. Neonatal sepsis is associated with systolic and diastolic myocardial dysfunction. Bacteremia can also occur without clinical signs.
Did the mother have epidural analgesia? Studies have shown an increase in maternal intrapartum fever (15–20%) with the use of epidural analgesia. Because of this fever, an increase in sepsis evaluations and antibiotic treatment was found. However, the study did not find that epidurals caused infections or even increased the risk of infections.
Was the mother tested for GBS, and did she receive antibiotics if she tested positive? There are now specific guidelines to follow after delivery if the mother was treated for GBS.
Did the mother have chorioamnionitis? See definition above. Chorioamnionitis is a major risk factor for sepsis, and its incidence varies inversely with gestational age. Histological chorioamnionitis increases the chance of having markers of infection (increased C-reactive proteins and neutrophilia, bacterial colonization [by gastric lavage and ear swab] and congenital sepsis). Fourteen to twenty-eight percent of mothers who deliver preterm infants at 22 to 28 weeks have signs of chorioamnionitis. Risk factors for chorioamnionitis include spontaneous labor, low parity, multiple digital vaginal examinations, meconium-stained amniotic fluid, presence of genital tract microorganisms, long length of labor and membrane rupture, and internal fetal or uterine monitoring.