Neonatal sepsis, or infection in babies under 28 days old, is commonly caused by bacteria and can lead to organ failure and death.
Although these cases occur worldwide, the highest number of infections and deaths are reported in low- and middle-income countries. In these regions, including Kenya, 6.9 million cases of serious bacterial infections are documented each year, resulting in 680,000 related deaths.
In 2022 alone, 9,000 babies in Kenya died due to sepsis. Dr. Christina Obiero, a researcher at the KEMRI Wellcome Trust in Kilifi and a pediatrician at Kilifi Referral Hospital, discussed the causes of sepsis infection during an interview on Baraka FM’s Jukwaa La Utafiti program.
Underweight Babies
Dr. Christina explains that a newborn should weigh at least 2.5 kg. Babies born below this weight are at a higher risk of contracting infections due to their weak immune systems. Research from the National Institutes of Health supports this claim, indicating that newborns with low birth weights are 1.42 times more likely to develop neonatal sepsis compared to babies of normal weight.
Prematurity
Babies born before 37 weeks face a higher risk of blood infections because their bodies are underdeveloped and lack essential antibodies to fight infections. Complications during pregnancy, labor, and delivery can also expose the baby to infections. Additionally, the use of catheters and intravenous (IV) lines during caregiving can be a source of infection.
Neonatal Resuscitation
Dr. Christina explains that the process of helping a baby breathe properly can expose them to sepsis. Suctioning, which removes mucus and other fluids from the nose, mouth, or throat, as well as endotracheal intubation (inserting a tube into the trachea to assist with breathing), can increase the risk of infection.
Prolonged Labor
Labor that lasts unusually long—around 20 hours for first-time mothers and 14 hours for those who have given birth before—can expose the baby to infections. Prolonged rupture of membranes, chorioamnionitis (infection of the placenta, amniotic fluid, and membranes surrounding the fetus), and fetal distress caused by long labor hours can also lead to complications and an increased risk of infection.
Maternal Infection
Dr. Christina also points out that mothers can expose their babies to infections before and during delivery through conditions like urinary tract infections (UTIs), pneumonia, and severe bacterial infections of the uterus.
Signs and Symptoms
Dr. Christina further explained how to recognize the signs of sepsis in a newborn:
Abnormal body temperature (high or low)
Feeding difficulties
Breathing problems
Tiredness or inactivity
Excessive sleepiness
Yellowing of the eyes and skin
She also mentioned that doctors conduct blood tests to check for infections, and an abnormal white blood cell count (either high or low) can be a sign of sepsis.
Treatment
Once tests confirm sepsis, babies are treated with antibiotics. Dr. Christina elaborates on the treatment process: “We typically start with first-line antibiotics, such as penicillin. If complications arise, we ensure that the right treatment is provided. Babies with severe infections may have difficulty breastfeeding, so we focus on maintaining the right balance of fluids and electrolytes through intravenous (IV) therapy. We also recommend incubating newborns who have low body temperatures.”
Challenges
Despite efforts to combat neonatal sepsis, Dr. Christina highlights several challenges, such as the lack of data at the county level. “The statistics on infant blood infections in 2022 remain unchanged because we are still using the same antibiotics, which face resistance. Our hospitals continue to struggle with long-standing problems, and we lack research data that clearly defines the number of cases.”
What KEMRI Wellcome Trust – Kilifi is Doing
Dr. Christina mentions that the institute is researching to improve the health of newborns with infections by identifying the bacteria involved and understanding how they evolve, which complicates antibiotic treatment. They are also studying the most effective ways to diagnose neonatal sepsis, determining the best tests to use, and identifying the most successful treatments. For example, they are set to begin research on different types of antibiotics for treating sepsis in infants at Kilifi Referral Hospital, Coast General Hospital, and Mbagathi Hospital in Nairobi.
Neonatal sepsis remains a significant health challenge, particularly in low- and middle-income countries like Kenya. However, there is hope in finding a solution by addressing issues such as improving data collection and enhancing antibiotic treatment strategies.
