BACTERIAL SEPSIS AND MENINGITIS - Nizet Laboratory at UCSD

TABLE 6–15 Differential Diagnosis: Clinical Signs Associated with Neonatal Sepsis and Some Noninfectious Conditions—cont’d
Hypoglycemia
Inborn errors of metabolism, including galactosemia, urea cycle disorders, organic acidemias
Ileus secondary to pneumonia
Congenital adrenal hyperplasia
Gastric perforation
Neonatal drug withdrawal syndrome
Lethargy
CNS disease, including hemorrhage, hypoxia, or subdural effusion
Congenital heart disease
Neonatal drug withdrawal syndrome
Hypoglycemia
Hypercalcemia
Familial dysautonomia
Seizure Activity (Tremors, Hyperactivity, Muscular Twitching)
Hypoxia
Intracranial hemorrhage or kernicterus
Congenital CNS malformations
Neonatal drug withdrawal syndrome
Hypoglycemia
Hypocalcemia
Hyponatremia, hypernatremia
Hypomagnesemia
Inborn errors of metabolism, including urea cycle disorders, organic acidemias, galactosemia, glycogen storage disease, peroxisomal disorders
Pyridoxine deficiency
Petechiae, Purpura, and Vesiculopustular Lesions
Birth trauma
Blood group incompatibility
Neonatal isoimmune thrombocytopenia
Maternal idiopathic thrombocytopenic purpura
Maternal lupus erythematosus
Drugs administered to mother
Giant hemangioma (Kasabach-Merritt syndrome)
Thrombocytopenia with absent radii syndrome
Disseminated intravascular coagulopathy
Coagulation factor deficiencies
Congenital leukemia
Child abuse
Cutaneous histiocytosis
CNS, central nervous system; G6PD, glucose-6-phosphate dehydrogenase.
FEVER AND HYPOTHERMIA
The temperature of an infant with sepsis may be elevated,
depressed, or normal [447–453]. In a multicenter survey
of nearly 250 infants with early-onset group B streptococcal
bacteremia, approximately 85% had a normal temperature
(36 C to 37.2 C [96.8 F to 99 F]) at the time of
their admission to the NICU [447]. Comparing temperatures
by gestational age, it was observed that term infants
were more likely to have fever than preterm infants (12%
versus 1%), whereas preterm infants more frequently had
CHAPTER 6 Bacterial Sepsis and Meningitis
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hypothermia (13% versus 3%). Phagocytes of an infant
born after an uncomplicated labor can produce adult concentrations
of interleukin-1, a potent pyrogen. The phagocytes
of infants born after cesarean section have a markedly
suppressed ability to produce this pyrogen [454]. In the
studies reviewed in Table 6–13, approximately half of the
infants had fever. Hypothermia, which was mentioned in
one study, occurred in 15% of the infants.
Fever is variably defined for newborns. A temperature
of 38 C (100.4 F) measured rectally generally is accepted