What is Late Onset Sepsis (LOS)?
Late Onset Sepsis (LOS) is a serious bloodstream infection that occurs in neonates and infants, typically after the first 72 hours of life. It is a significant cause of morbidity and mortality in
neonates, especially those in
NICUs.
What Causes LOS?
LOS is primarily caused by bacteria, but fungi and viruses can also be culprits. Common bacterial agents include
Staphylococcus aureus,
Escherichia coli, and
Klebsiella. The infection can be acquired through horizontal transmission from the hospital environment or vertical transmission from the mother.
Who is at Risk?
Infants at higher risk for LOS include those with
prematurity, low birth weight, prolonged use of intravenous catheters, and prolonged hospital stays. Other risk factors include mechanical ventilation and exposure to broad-spectrum antibiotics.
What are the Symptoms?
Symptoms of LOS can be non-specific and may include fever, lethargy, poor feeding, respiratory distress, and irritability. Due to the vague nature of these symptoms, LOS can be challenging to diagnose early.
How is LOS Diagnosed?
Diagnosis typically involves a combination of
clinical evaluation and laboratory tests. Blood cultures are essential for identifying the causative organism. Other tests may include cerebrospinal fluid analysis, urine cultures, and imaging studies.
What are the Treatment Options?
Treatment usually involves
antibiotic therapy, tailored based on the identified organism and its antimicrobial susceptibility profile. Supportive care, including fluid management, respiratory support, and nutritional support, is also crucial. In some cases, surgical intervention may be necessary to remove infected devices or abscesses.
How Can LOS Be Prevented?
Prevention strategies for LOS include strict adherence to
infection control protocols in NICUs, appropriate hand hygiene, and judicious use of invasive devices. Breastfeeding and timely removal of unnecessary catheters can also reduce the risk.
What is the Prognosis?
The prognosis for infants with LOS varies. Early diagnosis and prompt treatment are critical for improving outcomes. However, LOS can lead to severe complications, including meningitis, septic shock, and long-term neurodevelopmental impairments.
What are the Long-term Implications?
Long-term implications of LOS can include developmental delays, cognitive impairments, and chronic lung disease. Follow-up care is essential to monitor and address any ongoing health issues.
Conclusion
Late Onset Sepsis is a significant concern in pediatrics, requiring a high index of suspicion, prompt diagnosis, and effective management. Preventive measures and early interventions are key to improving outcomes for affected infants.
