Neonatal E. coli

Escherichia coli (E. coli) is a bacterium that normally inhabits the digestive tracts of humans and other animals. Most forms of E. coli do not make people sick; in fact, E. coli actually plays an important role in digestion. However, some strains of E. coli are pathogenic, meaning that they cause disease.

People can become exposed to E.coli by ingesting feces, typically from eating contaminated foods (including meat that has not been cooked thoroughly, unwashed vegetables, etc.) or drinking contaminated water. E. coli can also be spread from live animals to people, or from person to person. Frequent hand-washing helps to prevent this.

In adults and older children, exposure to pathogenic E. coli can cause diarrhea (sometimes containing blood), vomiting, painful abdominal cramps, urinary tract infections (UTIs), exhaustion, and fever. In rare cases, it can lead to kidney failure and even death, but most people recover in five to 10 days (1).

Pathogenic E. coli can be present in a woman’s vagina, and the baby can become infected during delivery. Infants can also be exposed to E. coli after birth; studies have shown that contaminated hands and uniforms of medical professionals are common vectors for transmission (2).

Pregnant women should be screened for harmful bacteria if they show signs of infection, as well as during routine prenatal appointments (urine cultures are typically taken during the first prenatal appointment and again in the third trimester – more often if a woman has a risk factors such as recurrent UTIs). It is very important that clinicians do these tests even if a patient is not showing symptoms of illness, because exposure to pathogenic E. coli and other maternal infections can be very dangerous to infants. If a mother has a serious infection, she should be given an antibiotic regimen that is safe for her as well as the baby. Doctors should also test the bacteria for resistance to certain antibiotics and use this information to determine an appropriate prescription. E. coli is often resistant to ampicillin.

Left untreated, maternal E. coli can result in neonatal sepsis (infection of the baby’s blood). While Group B. Strep is a more common cause of neonatal sepsis, E. coli sepsis is more likely to be fatal. E. coli is also the most common cause of sepsis in premature infants. The overall rate of E. coli infection at birth is .28 per 1,000 live births (3).

Risk factors for E. coli sepsis include:

• Prematurity or very low birth weight
• Intrapartum fever (4)
• Premature rupture of membranes (PROM), because this gives bacteria more time to ascend the birth canal (5).
• Mother shows signs of urinary tract infection (UTI)

Signs of neonatal sepsis include:

• Fever/fluctuating body temperature
• Labored breathing
• Lack of energy
• Refusal to eat
• Vomiting
• Jaundice
• Swollen abdomen
• Diarrhea (6)

Neonatal sepsis must be treated promptly with antibiotics. Which antibiotics should be given depends on a variety of factors, such as the infant’s age, severity of the infection, and sensitivity of the bacterium in question. Commonly-prescribed drugs include ampicillin and gentamicin. Because sepsis is a very serious condition, doctors often treat suspected cases before confirming the exact nature of the disease through lab work (7).   Babies with neonatal sepsis do very well with timely diagnosis and treatment.

If sepsis is severe or goes untreated, it can lead to meningitis. Meningitis is an infection of the membranes surrounding the brain and spinal cord. Signs of meningitis include:

• Abnormal body temperature
• Lack of energy
• Coma
• Vomiting
• Bulging fontanelle (soft spot on head)
• Seizures (6)

Like sepsis, meningitis is often treated before a formal diagnosis is made. If treated quickly and appropriately, infants with meningitis may make a full recovery. However, if treatment is postponed or inappropriate, infants can be brain damaged and develop lifelong conditions such as cerebral palsy, seizure disorders, or developmental disabilities.