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Neonatal Septic Shock

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Neonatology

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Abstract

Neonatal sepsis continues to be a major health problem in the world. Over the last decade, there has been an overall decrease in the incidence of neonatal sepsis. The institution of intrapartum Group B Streptococcus (GBS) prophylaxis has also led to a decrease in GBS early-onset disease. Early recognition and treatment of sepsis is essential to halt its progression to severe sepsis and septic shock. In this chapter, we compare the essential differences between the hemodynamic response to shock in neonates and older children. We also discuss various factors that make diagnosis and treatment of neonatal shock challenging. The American College of Critical Care Medicine recently published an update to their clinical practice parameters for the management of septic shock. We summarize these guidelines and briefly review thrombocytopenia-associated multiple organ failure in sepsis.

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References

  • (2009) Trends in perinatal group B streptococcal disease – United States, 2000–2006. MMWR Morb Mortal Wkly Rep 58:109–112

    Google Scholar 

  • Angus DC, Linde-Zwirble WT, Lidicker J, Clermont G, Carcillo J, Pinsky MR (2001) Epidemiology of severe sepsis in the United States: analysis of incidence, outcome, and associated costs of care. Crit Care Med 29:1303–1310

    Article  CAS  Google Scholar 

  • Baker CF, Barks JD, Engmann C, Vazquez DM, Neal CR Jr, Schumacher RE, Bhatt-Mehta V (2008) Hydrocortisone administration for the treatment of refractory hypotension in critically ill newborns. J Perinatol 28:412–419

    Article  CAS  Google Scholar 

  • Banerjea MC, Speer CP (2002) The current role of colony-stimulating factors in prevention and treatment of neonatal sepsis. Semin Neonatol 7:335–349

    Article  CAS  Google Scholar 

  • Bedford Russell AR, Emmerson AJ, Wilkinson N, Chant T, Sweet DG, Halliday HL, Holland B, Davies EG (2001) A trial of recombinant human granulocyte colony stimulating factor for the treatment of very low birthweight infants with presumed sepsis and neutropenia. Arch Dis Child Fetal Neonatal Ed 84:F172–F176

    Article  CAS  Google Scholar 

  • Benjamin DK Jr, DeLong ER, Steinbach WJ, Cotton CM, Walsh TJ, Clark RH (2003) Empirical therapy for neonatal candidemia in very low birth weight infants. Pediatrics 112:543–547

    Article  Google Scholar 

  • Bilgin K, Yaramis A, Haspolat K, Tas MA, Gunbey S, Derman O (2001) A randomized trial of granulocyte-macrophage colony-stimulating factor in neonates with sepsis and neutropenia. Pediatrics 107:36–41

    Article  CAS  Google Scholar 

  • Brian Smith P, Steinbach WJ, Benjamin DK Jr (2005) Invasive Candida infections in the neonate. Drug Resist Updat 8:147–162

    Article  CAS  Google Scholar 

  • Brierley J, Carcillo JA, Choong K, Cornell T, Decaen A, Deymann A, Doctor A, Davis A, Duff J, Dugas MA, (2009) Clinical practice parameters for hemodynamic support of pediatric and neonatal septic shock: 2007 update from the American College of Critical Care Medicine. Crit Care Med 37:666–688

    Article  Google Scholar 

  • Carcillo JA, Fields AI (2002) Clinical practice parameters for hemodynamic support of pediatric and neonatal patients in septic shock. Crit Care Med 30:1365–1378

    Article  Google Scholar 

  • Carcillo JA, Doughty L, Kofos D, Frye RF, Kaplan SS, Sasser H, Burckart GJ (2003) Cytochrome P450 mediated-drug metabolism is reduced in children with sepsis-induced multiple organ failure. Intensive Care Med 29:980–984

    Article  Google Scholar 

  • Carr R, Brocklehurst P, Dore CJ, Modi N (2009) Granulocyte-macrophage colony stimulating factor administered as prophylaxis for reduction of sepsis in extremely preterm, small for gestational age neonates (the PROGRAMS trial): a single-blind, multicentre, randomised controlled trial. Lancet 373:226–233

    Article  CAS  Google Scholar 

  • Cawley MJ, Briggs M, Haith LR Jr, Reilly KJ, Guilday RE, Braxton GR, Patton ML (1999) Intravenous immunoglobulin as adjunctive treatment for streptococcal toxic shock syndrome associated with necrotizing fasciitis: case report and review. Pharmacotherapy 19:1094–1098

    Article  CAS  Google Scholar 

  • Chapman RL (2003) Candida infections in the neonate. Curr Opin Pediatr 15:97–102

    Article  Google Scholar 

  • Cooke RWI (1992) Report of working group of the British Association of Perinatal Medicine and Neonatal Nurses Association on categories of babies requiring neonatal care. Arch Dis Child 67:868–869

    Google Scholar 

  • Dempsey EM, Barrington KJ (2006) Diagnostic criteria and therapeutic interventions for the hypotensive very low birth weight infant. J Perinatol 26:677–681

    Article  CAS  Google Scholar 

  • Dempsey EM, Barrington KJ (2009) Evaluation and treatment of hypotension in the preterm infant. Clin Perinatol 36:75–85

    Article  CAS  Google Scholar 

  • Despond O, Proulx F, Carcillo JA, Lacroix J (2001) Pediatric sepsis and multiple organ dysfunction syndrome. Curr Opin Pediatr 13:247–253

    Article  CAS  Google Scholar 

  • Fanaroff AA, Stoll BJ, Wright LL, Carlo WA, Ehrenkranz RA, Stark AR, Bauer CR, Donovan EF, Korones SB, Laptook AR et al (2007) Trends in neonatal morbidity and mortality for very low birthweight infants. Am J Obstet Gynecol 196(147):e141–e148

    Google Scholar 

  • Goldman S, Ellis R, Dhar V, Cairo MS (1998) Rationale and potential use of cytokines in the prevention and treatment of neonatal sepsis. Clin Perinatol 25:699–710

    Article  CAS  Google Scholar 

  • Goldstein B, Nadel S, Peters M, Barton R, Machado F, Levy H, Haney DJ, Utterback B, Williams MD, Giroir BP (2006) ENHANCE: results of a global open-label trial of drotrecogin alfa (activated) in children with severe sepsis. Pediatr Crit Care Med 7:200–211

    Article  Google Scholar 

  • Graves GR, Rhodes PG (1984) Tachycardia as a sign of early onset neonatal sepsis. Pediatr Infect Dis 3:404–406

    Article  CAS  Google Scholar 

  • Gurevich P, Ben-Hur H, Czernobilsky B, Nyska A, Zuckerman A, Zusman I (1995) Pathology of lymphoid organs in low birth weight infants subjected to antigen-related diseases: a morphological and morphometric study. Pathology 27:121–126

    Article  CAS  Google Scholar 

  • Hallwirth U, Pomberger G, Zaknun D, Szepfalusi Z, Horcher E, Pollak A, Roth E, Spittler A (2002) Monocyte phagocytosis as a reliable parameter for predicting early-onset sepsis in very low birthweight infants. Early Hum Dev 67:1–9

    Article  CAS  Google Scholar 

  • Han YY, Carcillo JA, Dragotta MA, Bills DM, Watson RS, Westerman ME, Orr RA (2003) Early reversal of pediatric-neonatal septic shock by community physicians is associated with improved outcome. Pediatrics 112:793–799

    Article  Google Scholar 

  • Haque K, Mohan P (2003) Pentoxifylline for neonatal sepsis. Cochrane Database Syst Rev CD004205

    Google Scholar 

  • Hartman M, Clermont G, Angus D, Watson R (2008) Pediatric severe sepsis in the US: 1995 vs. 2005. Crit Care Med 36:A76

    Google Scholar 

  • Hotchkiss RS, Tinsley KW, Swanson PE, Schmieg RE Jr, Hui JJ, Chang KC, Osborne DF, Freeman BD, Cobb JP, Buchman TG et al (2001) Sepsis-induced apoptosis causes progressive profound depletion of B and CD4+ T lymphocytes in humans. J Immunol 166:6952–6963

    Article  CAS  Google Scholar 

  • Janota J, Stranak Z, Belohlavkova S, Mudra K, Simak J (2001) Postnatal increase of procalcitonin in premature newborns is enhanced by chorioamnionitis and neonatal sepsis. Eur J Clin Invest 31:978–983

    Article  CAS  Google Scholar 

  • Jenson HB, Pollock BH (1998) The role of intravenous immunoglobulin for the prevention and treatment of neonatal sepsis. Semin Perinatol 22:50–63

    Article  CAS  Google Scholar 

  • Kashlan F, Smulian J, Shen-Schwarz S, Anwar M, Hiatt M, Hegyi T (2000) Umbilical vein interleukin 6 and tumor necrosis factor alpha plasma concentrations in the very preterm infant. Pediatr Infect Dis J 19:238–243

    Article  CAS  Google Scholar 

  • Kaufman D (2004) Fungal infection in the very low birthweight infant. Curr Opin Infect Dis 17:253–259

    Article  Google Scholar 

  • Kreymann KG, de Heer G, Nierhaus A, Kluge S (2007) Use of polyclonal immunoglobulins as adjunctive therapy for sepsis or septic shock. Crit Care Med 35:2677–2685

    CAS  PubMed  Google Scholar 

  • Krueger M, Nauck MS, Sang S, Hentschel R, Wieland H, Berner R (2001) Cord blood levels of interleukin-6 and interleukin-8 for the immediate diagnosis of early-onset infection in premature infants. Biol Neonate 80:118–123

    Article  CAS  Google Scholar 

  • Kucukoduk S, Sezer T, Yildiran A, Albayrak D (2002) Randomized, double-blinded, placebo-controlled trial of early administration of recombinant human granulocyte colony-stimulating factor to non-neutropenic preterm newborns between 33 and 36 weeks with presumed sepsis. Scand J Infect Dis 34:893–897

    Article  Google Scholar 

  • Kuster H, Weiss M, Willeitner AE, Detlefsen S, Jeremias I, Zbojan J, Geiger R, Lipowsky G, Simbruner G (1998) Interleukin-1 receptor antagonist and interleukin-6 for early diagnosis of neonatal sepsis 2 days before clinical manifestation. Lancet 352:1271–1277

    Article  CAS  Google Scholar 

  • La Gamma EF, De Castro MH (2002) What is the rationale for the use of granulocyte and granulocyte-macrophage colony-stimulating factors in the neonatal intensive care unit? Acta Paediatr Suppl 91:109–116

    Article  Google Scholar 

  • Miall-Allen VM, de Vries LS, Whitelaw AG (1987) Mean arterial blood pressure and neonatal cerebral lesions. Arch Dis Child 62:1068–1069

    Article  CAS  Google Scholar 

  • Moller JC, Nelskamp I, Jensen R, Reiss I, Kohl M, Gatermann S, Iven H, Gortner L (1997) Comparison of vancomycin and teicoplanin for prophylaxis of sepsis with coagulase negative staphylococci (CONS) in very low birth weight (VLBW) infants. J Perinat Med 25:361–367

    Article  CAS  Google Scholar 

  • Nandyal RR (2008) Update on group B streptococcal infections: perinatal and neonatal periods. J Perinat Neonatal Nurs 22:230–237

    Article  Google Scholar 

  • Ng PC, Cheng SH, Chui KM, Fok TF, Wong MY, Wong W, Wong RP, Cheung KL (1997) Diagnosis of late onset neonatal sepsis with cytokines, adhesion molecule, and C-reactive protein in preterm very low birthweight infants. Arch Dis Child Fetal Neonatal Ed 77:F221–F227

    Article  CAS  Google Scholar 

  • Ng PC, Lee CH, Bnur FL, Chan IH, Lee AW, Wong E, Chan HB, Lam CW, Lee BS, Fok TF (2006) A double-blind, randomized, controlled study of a “stress dose” of hydrocortisone for rescue treatment of refractory hypotension in preterm infants. Pediatrics 117:367–375

    Article  Google Scholar 

  • Nguyen T, Hall M, Han Y, Fiedor M, Hasset A, Lopez-Plaza I, Watson S, Lum L, Carcillo JA (2001) Microvascular thrombosis in pediatric multiple organ failure: is it a therapeutic target? Pediatr Crit Care Med 2:187–196

    Article  Google Scholar 

  • Pammi M, Haque KN (2015) Pentoxifylline for treatment of sepsis and necrotizing enterocolitis in neonates. Cochrane Database Syst Rev 3:CD004205

    Google Scholar 

  • Parravicini E, van de Ven C, Anderson L, Cairo MS (2002) Myeloid hematopoietic growth factors and their role in prevention and/or treatment of neonatal sepsis. Transfus Med Rev 16:11–24

    Article  Google Scholar 

  • Paternoster DM, Laureti E (1996) Persistent foetal tachycardia as an early marker of chorion-amnionitis. Description of a clinical case. Minerva Ginecol 48:371–374

    CAS  PubMed  Google Scholar 

  • Perry EH, Bada HS, Ray JD, Korones SB, Arheart K, Magill HL (1990) Blood pressure increases, birth weight-dependent stability boundary, and intraventricular hemorrhage. Pediatrics 85:727–732

    CAS  PubMed  Google Scholar 

  • Rogers BB, Alexander JM, Head J, McIntire D, Leveno KJ (2002) Umbilical vein interleukin-6 levels correlate with the severity of placental inflammation and gestational age. Hum Pathol 33:335–340

    Article  CAS  Google Scholar 

  • Romagnoli C, Frezza S, Cingolani A, De Luca A, Puopolo M, De Carolis MP, Vento G, Antinori A, Tortorolo G (2001) Plasma levels of interleukin-6 and interleukin-10 in preterm neonates evaluated for sepsis. Eur J Pediatr 160:345–350

    Article  CAS  Google Scholar 

  • Roman J, Velasco F, Fernandez F, Fernandez M, Villalba R, Rubio V, Torres A (1992) Protein C, protein S and C4b-binding protein in neonatal severe infection and septic shock. J Perinat Med 20:111–116

    Article  CAS  Google Scholar 

  • Roman J, Velasco F, Fernandez F, Fernandez M, Villalba R, Rubio V, Vicente A, Torres A (1993) Coagulation, fibrinolytic and kallikrein systems in neonates with uncomplicated sepsis and septic shock. Haemostasis 23:142–148

    CAS  PubMed  Google Scholar 

  • Sadana S, Mathur NB, Thakur A (1997) Exchange transfusion in septic neonates with sclerema: effect on immunoglobulin and complement levels. Indian Pediatr 34:20–25

    CAS  PubMed  Google Scholar 

  • Schiffl H, Lang SM, Fischer R (2002) Daily hemodialysis and the outcome of acute renal failure. N Engl J Med 346:305–310

    Article  Google Scholar 

  • Schroder CH, Severijnen RS, Potting CM (1992) Continuous arteriovenous hemofiltration (CAVH) in a premature newborn as treatment of overhydration and hyperkalemia due to sepsis. Eur J Pediatr Surg 2:368–369

    Article  CAS  Google Scholar 

  • Silveira RC, Procianoy RS (1999) Evaluation of interleukin-6, tumour necrosis factor-alpha and interleukin-1beta for early diagnosis of neonatal sepsis. Acta Paediatr 88:647–650

    Article  CAS  Google Scholar 

  • Smith OP, White B, Vaughan D, Rafferty M, Claffey L, Lyons B, Casey W (1997) Use of protein-C concentrate, heparin, and haemodiafiltration in meningococcus-induced purpura fulminans. Lancet 350:1590–1593

    Article  CAS  Google Scholar 

  • Smulian JC, Vintzileos AM, Lai YL, Santiago J, Shen-Schwarz S, Campbell WA (1999) Maternal chorioamnionitis and umbilical vein interleukin-6 levels for identifying early neonatal sepsis. J Matern Fetal Med 8:88–94

    CAS  PubMed  Google Scholar 

  • Soliman AT, Taman KH, Rizk MM, Nasr IS, Alrimawy H, Hamido MS (2004) Circulating adrenocorticotropic hormone (ACTH) and cortisol concentrations in normal, appropriate-for-gestational-age newborns versus those with sepsis and respiratory distress: cortisol response to low-dose and standard-dose ACTH tests. Metabolism 53:209–214

    Article  CAS  Google Scholar 

  • Stiehm ER (1997) Human intravenous immunoglobulin in primary and secondary antibody deficiencies. Pediatr Infect Dis J 16:696–707

    Article  CAS  Google Scholar 

  • Stoll BJ, Holman RC, Schuchat A (1998) Decline in sepsis-associated neonatal and infant deaths in the United States, 1979 through 1994. Pediatrics 102:e18

    Article  CAS  Google Scholar 

  • Stoll BJ, Hansen N, Fanaroff AA, Wright LL, Carlo WA, Ehrenkranz RA, Lemons JA, Donovan EF, Stark AR, Tyson JE et al (2002a) Changes in pathogens causing early-onset sepsis in very-low-birth-weight infants. N Engl J Med 347:240–247

    Article  Google Scholar 

  • Stoll BJ, Hansen N, Fanaroff AA, Wright LL, Carlo WA, Ehrenkranz RA, Lemons JA, Donovan EF, Stark AR, Tyson JE et al (2002b) Late-onset sepsis in very low birth weight neonates: the experience of the NICHD neonatal research network. Pediatrics 110:285–291

    Article  Google Scholar 

  • The Acute Respiratory Distress Syndrome, N (2000) Ventilation with lower tidal volumes as compared with traditional tidal volumes for acute lung injury and the acute respiratory distress syndrome. N Engl J Med 342:1301–1308

    Article  Google Scholar 

  • Togari H, Mikawa M, Iwanaga T, Matsumoto N, Kawase A, Hagisawa M, Ogino T, Goto R, Watanabe I, Kito H et al (1983) Endotoxin clearance by exchange blood transfusion in septic shock neonates. Acta Paediatr Scand 72:87–91

    Article  CAS  Google Scholar 

  • Volk HD, Reinke P, Krausch D, Zuckermann H, Asadullah K, Muller JM, Docke WD, Kox WJ (1996) Monocyte deactivation – rationale for a new therapeutic strategy in sepsis. Intensive Care Med 22(Suppl 4):S474–S481

    Article  Google Scholar 

  • Wardle SP, Yoxall CW, Weindling AM (1999) Peripheral oxygenation in hypotensive preterm babies. Pediatr Res 45:343–349

    Article  CAS  Google Scholar 

  • Watson RS, Carcillo JA, Linde-Zwirble WT, Clermont G, Lidicker J, Angus DC (2003) The epidemiology of severe sepsis in children in the United States. Am J Respir Crit Care Med 167:695–701

    Article  Google Scholar 

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Authors and Affiliations

  1. Departments of Critical Care Medicine and Pediatrics, University of Pittsburgh School of Medicine, Children’s Hospital of Pittsburgh, Pittsburgh, PA, USA

    Rajesh K. Aneja & Joseph A. Carcillo

  2. Division of Neonatology, Temple University, West Penn Hospital, Pittsburgh, PA, USA

    Ruby V. Aneja

  3. Division of Neonatology, University of Pittsburgh School of Medicine, Children’s Hospital of Pittsburgh, Pittsburgh, PA, USA

    Misty Good

Authors
  1. Rajesh K. Aneja
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  2. Ruby V. Aneja
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  3. Misty Good
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  4. Joseph A. Carcillo
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Corresponding author

Correspondence to Rajesh K. Aneja .

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Editors and Affiliations

  1. Department of Pediatrics Obstetrics and Reproductive Medicine, University of Siena, Siena, Italy

    Giuseppe Buonocore

  2. Department of Pediatrics Obstetrics and Reproductive Medicine, University of Siena, Siena, Italy

    Rodolfo Bracci

  3. Liverpool Women’s Hospital Neonatal Unit, Liverpool, UK

    Michael Weindling

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Aneja, R.K., Aneja, R.V., Good, M., Carcillo, J.A. (2018). Neonatal Septic Shock. In: Buonocore, G., Bracci, R., Weindling, M. (eds) Neonatology. Springer, Cham. https://doi.org/10.1007/978-3-319-29489-6_255

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  • DOI: https://doi.org/10.1007/978-3-319-29489-6_255

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