Neonatal Sepsis

When an expecting mother or her newborn child go into sepsis, it is a life-threatening emergency that requires urgent medical attention. Symptoms can begin suddenly as inflammation and the infection spreads through the bloodstream.

Anyone who has contracted an infection is at risk of developing sepsis, especially newborn babies who do not have a developed immune system at birth. An expecting mother may be at risk for sepsis during her pregnancy, during labor and delivery, or even after giving birth, depending on when she was infected.

Newborns can sustain devastating birth injuries if the inflammation from sepsis reaches their brain. When this happens, the child is at a high risk for blood clots, brain damage, and conditions like hypoxic-ischemic encephalopathy (HIE) because of the blocked oxygen and reduced blood flow. HIE is the leading cause of cerebral palsy and can cause irreversible developmental delays.

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Healthcare providers must act quickly when they recognize the initial signs of a septic reaction because even a slightly delayed response can have fatal consequences. When medical professionals fail to treat a maternal infection or neonatal infection, fail to identify the onset of sepsis, fail to treat it in a timely manner, or miss critical birth complications from it afterward, they may be held liable for committing medical malpractice.

Sepsis is an extreme bodily reaction to an infection. It is marked by widespread inflammation that travels through the bloodstream and triggers fever-like conditions and even seizures in patients.

Sepsis can come on suddenly and rapidly progress to the point of causing permanent damage within hours. The CDC estimates that nearly 1.7 million American adults go into severe sepsis annually from infections, and that around 20% of patients die from it. It’s estimated that more than 75,000 newborns develop the condition each year in the United States. One estimate from The University of Florida Health Center claims that more than 18 infants die from sepsis each day.

Whenever maternal infections or neonatal infections occur, it triggers the immune system to respond and fight them off with proteins, antibodies, and white blood cells.

These immune system components travel through the bloodstream to find the infection and attack it, which causes inflammation. Inflammation can be identified by swelling, redness, pain or tenderness, and excess warmth around the infected area. While inflammation can feel uncomfortable, it is a part of the body’s natural healing process and means the immune system is doing its job.

Sometimes, however, the body’s immune system creates too many infection-fighting proteins (called cytokines), causing widespread inflammation throughout the body and bloodstream. This can cause blood clots, tissue damage, organ dysfunction and failure, seizures, and even death.

Septicemia (also known as blood poisoning) is the name of an infection that occurs when harmful bacteria enter the bloodstream. Septicemia can trigger sepsis, but the two terms are not interchangeable.

It’s important to remember that sepsis isn’t actually an infection, but rather a widespread bodily response to an infection. Sepsis and septicemia often go hand in hand, but while almost all cases of septicemia lead into sepsis, not all cases of sepsis are caused by septicemia.

Expecting mothers and newborns who have an underlying infection are at the highest risk for going into sepsis. Two of the most common infections that can trigger sepsis in pregnant women are Group B Streptococcus and Escherichia coli (E. Coli). However, it’s important to know that sepsis is more commonly observed after pregnancy than during it.

A number of factors can increase the risk for contracting infections that can develop into sepsis:

• Age: As people age, their immune system naturally weakens. This is known as immunosenescence, and while the effect is stronger later in life (around age 60), the process begins in early adulthood.
  
  Expecting mothers who are on the later end of their reproductive years (age 35+) may experience a greater deficiency in their immune system, increasing their risk of a septic reaction from infections during and after pregnancy.
  
  Additionally, on the opposite end of the spectrum, newborns are at an increased risk for sepsis because of their early age and underdeveloped immune systems.
• Underlying Medical Conditions: Someone’s immune system can be weakened for other reasons beyond age. Certain autoimmune disorders like diabetes, rheumatoid arthritis or ulcerative colitis can cause excess inflammation in the body, increasing a mother’s risk for going into sepsis when she contracts an infection.
  
  Other conditions, such as lung and heart diseases and various types of cancer, have also shown to diminish immune system function and can become a catalyst for contracting a septic infection.
• Extended Hospital Stay: A mother and her child’s risk for contracting infections increases the longer they stay in the hospital or neonatal intensive care unit (NICU). The risk of infection can come from unsterilized hospital equipment, interactions with other sick patients, or from contact with infected healthcare workers.
• C-Section Deliveries: When a mother requires a C-section delivery, there is a moderate risk of the incision getting infected. Any additional wounds or tears from the procedure may also become infected and increase the mother’s risk for sepsis.
• Invasive Medical Devices: Invasive medical devices like catheters, breathing and feeding tubes, and IVs can provide an easily accessible route for infections to enter and travel through the body. Mothers and newborns who need these devices may be at a heightened risk for an infection that can develop into sepsis.
  
  Healthcare professionals must identify these risks when they are present in expecting mothers or their newborns so they can prevent infections from developing into a case of sepsis.

Sepsis can be difficult to identify in the early stages because it can start out looking like a typical bodily reaction to an infection. It is unique in the sense that it is a systemic response; instead of inflammation happening only at the infection site, the entire body reacts and becomes inflamed. This can have dire effects on the mother or her newborn, especially if it progresses into a case of severe sepsis or septic shock.

Sepsis can be broken into multiple stages categorized by the onset of different symptoms:

In the beginning stage of sepsis, the mother or newborn will often have a fever accompanied by chills and an elevated heart rate (tachycardia). The inflammation in the bloodstream can cause low blood pressure and body aches. It is during this stage of sepsis when treatment is most critical to avoiding long-term harm for the mother or her baby.

Sepsis can develop into a severe case within a day or even multiple hours when left untreated or not treated enough. When a mother or newborn develops severe sepsis, they may begin to experience organ dysfunction.

Body aches will intensify into extreme pain, and blood pressure may drop even further below safe levels.

Strong changes in mood and mental ability may also occur, such as lethargy and confusion. This can be an indication that the inflammation is starting to reach the brain.

Septic shock is the final and most severe stage of sepsis. A mother or newborn going into septic shock is at risk for organ failure and death.

Septic shock can be marked by body convulsions, extremely low blood pressure, brain damage causing seizures and strokes, respiratory distress leading to lung failure, heart failure, and maternal death or infant death.

Treatment for septic shock is typically done in the intensive care unit (ICU) or neonatal intensive care unit (NICU). Even when treated, it’s estimated that nearly a third of patients don’t survive.

It’s important to note that as sepsis progresses, symptoms from earlier stages can still be present and intensify. Healthcare professionals must be able to swiftly identify these symptoms, especially in the early stages, to avoid permanent injury to the mother or her child.

A newborn can develop early-onset sepsis if they contract an infection at birth from the mother (known as a congenital infection). It is more commonly observed in premature infants.

A newborn’s case of sepsis is considered late-onset if they contract the infection after delivery in the hospital. This is more common in babies with birth complications such as having a low birth weight, requiring feeding through a G-tube, or an extended stay in the neonatal intensive care unit (NICU).

Early-onset sepsis will occur within the first few days of life, whereas late-onset sepsis can occur from a week after birth up until the 28th day of life. Both types are treated using the same methods.

Urgency is required when treating mothers and newborns suspected of undergoing sepsis. In 2006, a UK-based nonprofit called The Sepsis Trust coined “The Sepsis Six”, a bundle of medical treatment actions that healthcare professionals can take to reduce the risk of mortality from sepsis.

The Sepsis Six

• Taking blood cultures
• Starting intravenous (IV) antibiotics
• Starting intravenous (IV) fluids
• Providing high-flow oxygen
• Measuring serial serum lactate levels
• Measuring urine output

In addition to blood and urine tests, healthcare providers may also deem it necessary to run x-rays or CT scans to monitor the effect sepsis has taken on the body. They must also check the mother or child’s blood pressure and respiratory rates to identify any abnormalities.

Along with antibiotics, oxygen, and fluids, doctors may prescribe vasopressor medications to tighten the blood vessels if the mother or newborn has a dangerously low blood pressure. Surgery can sometimes be required later to remove damaged organ tissue.

Because of how quickly sepsis can progress, the standard of care is to begin treatment and administer IV antibiotics, oxygen, and fluids before receiving the positive results of the blood culture or urine test. This is because waiting for results to come back can take time that mothers or newborns in sepsis cannot afford to wait for.

In addition, blood and urine cultures can sometimes come back as negative even when the mother or baby is in sepsis. This can happen when sepsis is caused by a viral infection instead of a bacterial one. Because of this, it is also standard for healthcare providers to test the mother or newborn for common viral infections like influenza and COVID-19.

The severity of sepsis makes it critical for doctors, nurses, and specialized healthcare teams to act quickly and competently when treating affected mothers or newborns. Examples of medical negligence when treating sepsis can include:

• Missing or failing to treat a maternal infection or neonatal infection that progresses into sepsis.
• Making an improper incision or would during a C-section delivery that causes a septic infection.
• Failing to recognize the signs of sepsis in time before it progresses.
• Failure to identify a case of viral sepsis due to a negative blood or urine culture.
• Delaying treatment of a suspected sepsis case until positive culture results come back.
• Failure to administer the proper antibiotics or insufficient fluids to the mother or newborn.
• Failure to remove damaged tissue following a case of sepsis.

It’s important to note that it requires a detailed review of the specific facts and timeline of a sepsis case before making a definitive judgement as to whether medical malpractice played a factor in the mother’s or child’s sepsis-related birth injury.

What Are Six Signs of Sepsis?

A mother or newborn can show multiple signs of sepsis; there aren’t necessarily six characteristics that define each sepsis case. In 2018, the nonprofit organization Sepsis Alliances launched It’s About TIME, a campaign aiming to promote early detection of sepsis using the T.I.M.E. acronym to identify symptoms:

• T – Temperature (higher or lower than normal)
• I – Infection (signs or symptoms of an infection)
• M – Mental Decline (confusion, tiredness, etc.)
• E – Extremely Ill (severe pain, discomfort, shortness of breath)

In 2006, a UK-based nonprofit called The Sepsis Trust coined “The Sepsis Six,” a bundle of medical treatment actions that healthcare professionals can take to reduce the risk of mortality from sepsis. The Sepsis Six includes:

• Taking blood cultures
• Starting intravenous (IV) antibiotics
• Starting intravenous (IV) fluids
• Providing high-flow oxygen
• Measuring serial serum lactate levels
• Measuring urine output

The Sepsis Six is a helpful way to remember how to treat mothers and newborns with sepsis, but it isn’t used to identify their symptoms. In recent years, a new 6-part mnemonic S.E.P.S.I.S. was created, but its effectiveness has been debated.

How Long Does Sepsis Have To Become Fatal?

Sepsis can become fatal in as short as 12 hours, but it depends on numerous factors: the mother or newborn’s underlying conditions, the severity of the initial infection that caused sepsis, and how quickly treatment was given. For newborns, the risk of death increases by about 7.6% with every hour that passes without treatment.

What Does a Sepsis Rash Look Like?

Sometimes, a blood infection called septicemia can cause a mother or newborn to go into sepsis. Septicemia often comes with a reddish, discolored skin rash around the infected area or even around the entire body.

Is Sepsis Contagious?

Sepsis is not contagious. It is a bodily response to an infection. However, the infection that causes a mother’s or newborn’s case of sepsis can be contagious. Whether or not that same infection will induce a septic response in someone else can depend on their risk factors, including their age, their underlying health conditions, and how long the infection goes untreated.

Can You Get Sepsis From a Tooth Infection?

Yes. Bacterial infections can sometimes cause a tooth abscess, a pocket of pus that forms in the gums. It’s very easy for these infections to enter the blood stream and cause septicemia. Septicemia is a serious blood infection that can develop into sepsis when mismanaged or left untreated.

Can Sepsis Reoccur?

Yes, sepsis can reoccur. In fact, patients who have survived a septic episode are at an increased risk of having it again from future infections.

While sepsis can be life-threatening, a mother or her newborn can survive it without any permanent injury when they receive quick and proper medical treatment. Medical negligence, such as a misdiagnosis or failure to catch early symptoms an infection, can worsen a mother’s or newborn’s health and expose them to preventable birth injuries and other birth complications like organ failure and even death.

If a family believes medical negligence contributed to a mother’s or child’s sepsis-related injury, legal support may be an option. A specialized birth injury attorney can review the medical records and circumstances to assess whether a claim exists.

Parents whose children suffer from the long-term effects of birth complications, as well as parents who have suffered the loss of their baby, deserve to know whether it could have been prevented. Our dedicated birth injury lawyers want to help you find those answers and obtain the funds necessary to improve the quality of life for your child.

If your child has been diagnosed with a birth injury and you suspect this may have been caused in part by medical mistakes, Miller Weisbrod Olesky will thoroughly investigate the facts and hold the responsible medical providers accountable by pursuing medical malpractice claims against them.

Sometimes families are hesitant to reach out to a medical malpractice attorney or law firm. They may feel overwhelmed by their circumstances or are worried that a law firm will not be able to help them. But the only way to find out if you have a case is to talk to an attorney who understands how birth injuries can lead to developmental delays and other birth complications that require long-lasting medical support.

A statute of limitations (SOL) is a law that sets a time limit on how long an injured person has to file a lawsuit after an accident. It is essential to understand that statutes of limitations vary based on the type of case and the state where it is filed. For instance, the deadline for birth injury claims is typically different from other claims, such as injury to personal property, fraud, contract disputes, and collection of debts.

Generally, the clock starts ticking on the date the injury occurred. However, there are exceptions to this rule, and in some cases, the statute of limitations starts when a person discovers or reasonably should have discovered an injury. When dealing with government agencies, SOLs can become even more complex.

For example, if the party that injured you was:

• A federal employee
• Employed by a military hospital, Veterans Administration facility, or a federally funded medical entity

You may need to file a birth injury claim under the Federal Tort Claims Act (FTCA). In FTCA cases, claimants must go through certain administrative procedures before filing a lawsuit. In some states, if the negligent party was a local or state government hospital or the doctors and medical providers are employees of a governmental entity, the time period in which you must give "notice" may be shorter.

If your case is filed outside of the statute of limitations, it will typically be dismissed, and you will not be eligible to recover compensation for your injuries. Determining when a statute of limitations begins on your case can be tricky. If you're considering pursuing compensation for a birth injury, contacting an attorney as soon as possible is in your best interest.

Injuries and fatalities that trace back to a case of mismanaged or untreated sepsis can usually be prevented, but it takes a detailed expert review of the facts and circumstances of an infection case determine whether the injury was the result of medical malpractice.

Our Process

At Miller Weisbrod Olesky, a team of committed birth injury malpractice attorneys, nurses and paraprofessionals uses our detailed medical negligence case review process to assess your potential birth injury case. We start by learning more about you and your child and the status of meeting/missing developmental milestones. Then we gather medical records to determine what happened before, during, and after your delivery. We call in skilled medical experts who review your records and let us know if they think medical errors could have caused you or your child's injuries.

If we feel medical negligence caused or contributed to complications with your pregnancy or your child's injuries, we meet with you to discuss how you can receive compensation from the medical professionals who made the errors.

At no point in our legal intake process will we ask you to pay anything. The medical review of your case and the consultation are free. We only receive payment when you do. The sooner you reach out to us, the sooner we can begin investigating your case and gathering the evidence needed to support your claim.

We work on a contingency fee basis, meaning you won't pay any legal fees unless we win your case. Contact us today to schedule your free consultation by calling our toll-free line at 888-987-0005 or by filling out our online request form.