What is bacterial sepsis?
Bacterial sepsis is what doctors call it when bacteria gets into the bloodstream and causes a serious infection in an organ such as the kidneys or lungs, or in the bone, for example.
Sepsis can be treated with antibiotics, particularly if it's caught early, but even then, it can be lethal. Thanks to two vaccines — one of them fairly new — this kind of infection is becoming increasingly rare.
Hib vaccine has pretty much wiped out the childhood diseases caused by H. influenzae, and the recently introduced pneumoccocal vaccine (Prevnar) has been shown in some studies to reduce the risk of pneumococcus infections by more than 90 percent.
That means that unvaccinated children are now the most susceptible to blood infections, particularly those who are between 2 months and 36 months of age, when the immune system has not yet fully developed.
(Also at risk are children with certain conditions like sickle cell disease or HIV infection.) Babies under 2 months are protected from such bugs by antibodies they get from their mother in the womb. (When newborns do get blood infections, the usual cause is bacteria — such as group B strep — that they picked up from their mother during birth.)
"Then the risk begins to drop at age 2," says Gary Overturs, a professor of pediatrics at the University of New Mexico at Albuquerque, "and is almost gone by the time your child is 3, since by then her immune system is strong enough to fight off most bloodstream infections."
In rarer cases, a child may develop a blood infection from other bacteria such as Staphylococcus aureus and Group A streptococcus, which can sometimes enter the blood through a cut in the skin, or Neisseria meningitides, which comes in through the respiratory tract, or salmonella, which gets into the blood through the gut.
How can I tell if my child has bacterial sepsis? It's difficult. While some babies with a blood infection become fussy or lethargic, sometimes the only symptom is a fever. That's why it's so important to see a doctor if your child is younger than 3 months and has a rectal temperature higher than 100.4 degrees F, even if she has no other signs of illness.
If your baby is between 3 and 12 months old, take her in if her fever is higher than 102 degrees F. If your baby seems inconsolable, won't make eye contact, or is difficult to arouse, bring her in even if her fever is not that high.
Bloodstream infections from cuts, boils, or other skin disturbances are usually signaled by fever, pain, and severe redness around the wound. If you notice any of these symptoms, get your child to the doctor. This kind of bacterial sepsis can lead to serious problems in the bones and joints.
How is sepsis diagnosed and treated? When your baby has a fever, her doctor will examine her carefully for the source. She could have an ear, throat, or lung infection that you weren't aware of. If the doctor finds no signs of any of these, he'll be on high alert for sepsis.
Though most fevers are the result of viral infection, your baby will need to have a spinal tap (to check for bacterial meningitis), a blood draw (to check for sepsis), and perhaps a catheter to get a clean urine sample (to check for a urinary tract infection).
All of these things are invasive and can be stressful, but the dangers of serious illness are great enough that most doctors believe they're worth it. "Only 2 or 3 percent of feverish babies with no other symptoms will actually have sepsis," says Overturs.
"But when they're tiny, it's important to find out as quickly as possible." (If your baby has a wound that appears to be infected, the doctor will take a culture of it, if possible.)
The results of the blood test will come back in about 24 hours. While you're waiting, your baby will be given antibiotics. The doctor will decide whether your baby will stay in the hospital for IV antibiotics, receive an injection, or take oral antibiotics at home and come back the next day.
According to Overturs, about half the babies with suspected sepsis are hospitalized. Once the doctor confirms the diagnosis, your baby will continue taking antibiotics. Again, she can do this either in or out of the hospital.
The infection should clear up in a week or so, but it's very important to make sure your child takes the whole course of antibiotics and returns for any follow-up visits.
Is there any way to prevent sepsis? First, make sure your child's vaccinations are up to date. Try to keep your child's cuts clean, don't let her pick at boils or sores, and watch for signs of infection. Catching an infection early is the best medicine.