Septic Shock in Babies

Septic shock occurs when a baby develops sepsis (a bloodstream infection), and the sepsis progresses first to severe sepsis and then to septic shock. Sepsis in a newborn is typically caused by an infection in the mother that is passed on to the baby. Septic shock is a medical emergency that causes multiple organ dysfunction as well as dysfunction with the heart and blood flow. Usually, the baby’s blood pressure becomes critically low, which means that not enough oxygen is circulating to crucial organs like the brain. If sepsis is quickly and properly treated, septic shock will not occur.

Newborns develop sepsis by contracting an infection from the mother during – or occasionally before – delivery. This can can happen in several ways, including:

• Transmission to the baby through the amniotic fluid (fluid in the womb)
• Transmission from bacteria (such as Group B streptococcus (GBS) or E.coli) that is present in the mother’s genital tract, which the baby comes into contact with during delivery

Once bacteria gain access to the bloodstream, there may be overwhelming infection throughout the baby’s body (septicemia) and/or the infection can become localized in the baby’s lungs (pneumonia) or in the brain (meningitis).

This severe infection in the baby’s body can cause:

• Systemic inflammation (affects the whole body)
• Problems with the immune system
• Circulatory system dysfunction
• Major organ problems

When sepsis progresses to septic shock, the baby may have severe heart and vascular problems that prevent blood flow to the tissues. These issues which can cause organ damage include:

• Very low blood pressure
• Decreased urine output
• Metabolic acidosis (acidic blood)

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Doctors should promptly treat sepsis and septic shock in order to decrease the risk of meningitis. It cannot be emphasized enough that the key to preventing meningitis and septic shock in babies is prompt recognition and treatment of sepsis.

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Septic shock in a baby is diagnosed when the baby has:

• Signs of inadequate tissue perfusion (blood flow to the tissues)
• Suspected or proven infection
• Two signs of systemic inflammatory response syndrome (SIRS), which is an inflammatory state affecting the whole body. Signs of SIRS include: fast heart rate, high or low body temperature, fast breathing, and markers for infection (such as an abnormal number of white blood cells or immature white blood cells).

The serious medical problems that occur when a baby is in shock can create additional problems. Babies with septic shock may have:

• A need for a breathing machine called a ventilator (especially if the baby has pneumonia and/or respiratory distress)
• Fever
• Hypothermia (baby’s core body temperature is lower than normal)
• Very fast or very slow heart rate
• Cool extremities
• Very fast breathing, very slow breathing, or periods whereby breathing stops for 20 seconds or more (apnea)
• Low blood pressure
• Altered mental state (baby is irritable, anxious, lethargic, overly sleepy or apneic)
• Sunken eyes
• Decreased urine output

Another risk factor includes a central line catheter, which is a tool that is used to deliver medications, antibiotics, and/or blood straight to the heart. A baby with a central line infection may also display these signs. It is critical to recognize these signs and risks and promptly treat the infection in order to avoid septic shock and its consequences.

Babies that survive septic shock may have permanent brain injury and permanent disability, such as cerebral palsy. However, these can be prevented if septic shock is recognized early and prompt treatment is given.

The main goals of treatments given to babies who have septic shock are:

1. Restoring blood flow in the organ tissues (tissue perfusion)
2. Improving oxygen delivery to the baby’s tissues
3. Normalizing cellular metabolism (the energy demand and consumption of the body’s cells).

When a baby is in septic shock, supportive care and antibiotic treatment are equally important.

Antibiotic treatment is of such critical importance that physicians should begin administering these drugs even if sepsis is suspected; doctors should not delay treatment while waiting for test results confirming sepsis.

Supportive treatments may include:

It is critical that improvement in circulation, perfusion (blood flow and delivery of blood to tissues) and organ function occur within the first 6 hours of a baby going into septic shock, and this is the main goal of treatment. If improperly treated, the baby is at risk of developing heart and brain problems from complications associated with septic shock, such as low blood sugar (hypoglycemia) and low blood calcium (hypocalcemia). Other major problems include hypoxic-ischemic encephalopathy (HIE) or seizures.

Once medical professionals have recognized the septic shock and resuscitated the baby (when blood pressure, heart rate and other cardiovascular issues are stabilized), the baby may need to be transferred to a hospital that has neonatal critical care specialists. Babies in septic shock need to be treated by specialized teams; it’s also important that the team transporting the baby also have expertise in managing neonatal septic shock.

Recovery time from septic shock varies widely and is dependent upon many factors, including adequacy of organ function, blood pressure and perfusion. Lasting heart or lung problems can slow down recovery.

Since many babies with sepsis require help with breathing, it may be weeks before respiratory distress and pneumonia resolve enough to allow the baby to breathe on their own.

Some babies stay in the hospital for many weeks after septic shock.  If the baby has brain damage like hypoxic-ischemic encephalopathy (HIE), meningitis or cerebral palsy, they may need frequent and regular visits to neurologists, therapists and other specialists.

Septic shock can cause hypoxic-ischemic encephalopathy (HIE), seizures and cerebral palsy in numerous ways. The cardiovascular effects of shock can cause significant oxygen deprivation in the baby’s brain, which can cause permanent brain injury. Shock can also cause heart, liver and kidney dysfunction, which can also lead to brain damage. If the baby has significant breathing problems, such as pneumonia and/or respiratory distress, s/he is at risk of suffering from a lack of oxygen to the brain as well as overventilation injuries, which can cause cerebral palsy. Other issues caused by septic shock, such as metabolic problems, hypoglycemia, hypocalcemia and other electrolyte problems can either directly or indirectly affect the brain.