Infection and sepsis

Host Defence Mechanism

The incidence of sepsis is approximately 1:1000 in term

infants and 1:250 in preterm infants.

This increased susceptibility in preterm infants relates

to at least three factors:

Diminished maternally transferred antibodies Immature neonatal immune system

Increased risk of nosocomial infections due to a

complicated clinical course and prolonged hospitalization.

Transplacental Maternal Antibody

Transplacental maternal antibodies may protect

against certain infections in neonates, such as GBS infection. A lack of type-specific maternal antibodies is associated with an increased risk of GBS sepsis.
Furthermore, active transplacental transport of

maternal antibodies to the fetus occurs predominantly after 32 weeks of gestation.

Pre-Term Immunity
Serum IgG levels in preterm infants born prior to 32

weeks are usually 2-4 times lower than those of term infants.
The defence mechanism in neonates are more

important than maternal immunity

Nenonates have a lower level of serum complement

and phagocytic activities appear to be less effective , particularly during stress (eg. Sepsis, surgery)

Pre-Term Immunity
Cell-mediated immunity in preterm and newborn

infants is also believed to be less well-developed than older infants.

Preterm infants have fewer capillaries in all their

tissues than term infants, and consequently, their mobilization of natural defences may be poorer.
Inflammatory responses in immature hosts are also

deficient.

Pre-Term Immunity
Young and adult rabbits have been shown to have

different capacities to develop and localize inflammation at the site of injection of pneumococci.
In adult rabbits, a very extensive localinflammation

develops and bacteremia occurs only in relatively few rabbits.

Pre-Term Immunity
In contrast, young rabbits fail to develop extensive

local inflammation and consequently die with bacteremia.

Local reactions in these young rabbits were variable

(51% had no reaction, 36% had local redness only and 13% had redness and swelling).
Human newborns react similarly.
Textbook of Neonatal Medicine: A Chinese Perspective Hong Kong University Press, 1996 - 912 pages

Risk factors of Infection and Sepsis

Any stage Prematurity Neutropenia due to other cause
Early onset Sepsis Maternal GBS carrier Maternal HVS positive PROM >18 hours PPROM Chorioamnionitis Late Onset Sepsis Overcrowded nursery Inadequate hand washing Central lines Infection from family members or contacts.