Neonatale Sepsis - Ein Update

More than one million newborns die from sepsis every year. Often, the surviving children suffer from significant long-term morbidity. The increasing scientific progress in the understanding of the pathophysiology of neonatal sepsis precludes a hitherto insufficient clinical benefit to the newborn. The early onset sepsis contrasts with the later occurring late onset sepsis with significant differences in origin and type of pathogen, clinical presentation, diagnostic procedures and treatment. The most important risk factors for the development of sepsis - put alongside endogenous immunological peculiarities in premature infants and newborns - are birth weight, gestational age, length of hospital stay and the need for intensive care procedures. The evaluation and the initial management of neonates with suspected sepsis should include the expected microbial spectrum and microbiological screening studies, pregnancy and birth history, complete physical examination, laboratory and microbiological studies and rapid introduction of an empirical antibiotic therapy. Besides the established biochemical and microbiological methods for sepsis diagnosis, new procedures such as the determination of gene expression profiles, «Electric nose» and predictive monitoring for sepsis diagnostics are used increasingly. The differential diagnosis of neonatal sepsis includes other systemic infections and non-infectious causes, including withdrawal symptoms in association with maternal drug intake, metabolic disorders and congenital abnormalities of various organs. Possible prevention strategies in sepsis include not only participation in surveillance programs, but also breastmilk feeding, vaccination and targeted therapies, considering the immunological peculiarities in premature infants and neonates.