Killer sepsis in the first month of life, what are the causes and symptoms for newborns

What are the causes and symptoms of sepsis? "Sepsis continues to be a major global health emergency and a leading cause of mortality in newborns. According to the World Health Organization (WHO), it remains a leading cause of death in the first 28 days of life, especially in premature infants and in low-income countries. Internationally, the fatality rate is estimated at 10-20%, with higher rates in the most severe forms and in very low birth weight infants. Every year, thousands of families are affected by this condition, which, if recognized promptly, can be successfully treated."  

Because "every minute counts against neonatal sepsis." This is the explanation from the Italian Society of Neonatology (SIN) on the occasion of World Sepsis Day, which falls on September 13th. Neonatologists are drawing the attention of institutions, the medical community, and the public to the importance of early diagnosis, prevention of neonatal infections, and scientific research, which has made significant progress in recent years. "New scientific evidence is paving the way for faster diagnoses and increasingly personalized treatments," the SIN states. 

"The onset of sepsis in newborns can be particularly insidious. The initial symptoms," specialists describe, "can be very subtle: difficulty feeding, reduced responsiveness, changes in body temperature, difficulty breathing, pale or mottled skin. Even a delay of just a few hours in diagnosis can significantly alter the prognosis. One of the major challenges of neonatal sepsis is that diagnostic confirmation and targeted treatment are based on culture tests (the gold standard is blood culture), which require time, often 36-72 hours," the experts emphasize.  

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"In recent years, new diagnostic tools have been developed based on multiplex PCR, metagenomics, transcriptomics, metabolomics, and host gene profiling," explains Mario Giuffrè, secretary of the Neonatal Infectious Diseases study group at the SIN. "These technologies could identify infection many hours earlier than traditional methods, allowing for early initiation of antimicrobial therapy and, at the same time, personalizing it using the most appropriate molecules on a case-by-case basis, thus reducing the inappropriate use of antibiotics." 

A particularly relevant issue concerns "the growing spread of multidrug-resistant microorganisms, which makes it even more important to invest in infection prevention, microbiological surveillance, and antimicrobial stewardship programs to reduce the inappropriate use of antibiotics without delaying treatment of newborns actually suffering from sepsis," the SIN emphasizes. In 2025, the WHO published the first Target Product Profile dedicated to the development of rapid tests to identify serious bacterial infections in newborns and infants. The goal is to have tests that can be performed even in settings with limited resources, capable of rapidly distinguishing bacterial from viral infections and guiding specific therapy. In 2026, the Surviving Sepsis Campaign guidelines for pediatrics were updated, the Italian neonatologists note. Among the key messages highlighted were "the importance of increasingly early recognition, timely treatment, administration of antibiotics within the first hour in cases of septic shock, and intensification and improvement of follow-up, with particular reference to long-term outcomes after discharge." 

"Italy has an efficient network of neonatal intensive care units (NICUs) that participate in national neonatal infection surveillance programs," says Massimo Agosti, president of the Italian National Institute of Neonatal Medicine (SIN). "The research activities and collaborative networks promoted by the SIN, including Inn-SIN (the Italian Neonatal Network of the SIN), now enable us to collect national epidemiological data on neonatal infections, compare quality indicators across NICUs, monitor microbiological patterns and antibiotic resistance, promote shared prevention and treatment protocols, and develop projects for continuous quality improvement in care. Thanks to these networks, in recent years it has been possible to improve the quality of care, promote the appropriate use of antibiotics, and monitor the epidemiology of neonatal infections." 

Furthermore, the SIN's Neonatal Infectious Diseases study group—the scientific society continues—has repeatedly emphasized the importance of preventing healthcare-associated infections and containing the spread of multidrug-resistant pathogens in NICUs. Prevention, in fact, remains the most effective tool. Priority interventions include "the role of qualified obstetric care, prevention of maternal infections, hand hygiene, and breastfeeding. Appropriate use of antibiotics and effective infection surveillance systems in NICUs are equally crucial." 

"Invasive infections still represent one of the main complications of premature infants admitted to the neonatal intensive care unit," while "in full-term infants, early sepsis is now relatively rare, with an estimated incidence of well under 1 case per 1.000 live births," the SIN states, "thanks primarily to maternal screening for Streptococcus agalactiae and intrapartum antibiotic prophylaxis for at-risk cases. In very premature infants and extremely low birth weight infants (<1.500 g), however, late sepsis continues to be one of the most frequent complications during hospitalization, with incidences that can exceed 15-20% in the most vulnerable patients, although this varies between centers." Agosti, however, warns: "Sepsis, although rare, can also affect an apparently healthy newborn. Knowing the signs means saving lives. Research today provides us with increasingly sophisticated tools, but the most important factor remains early recognition and timely access to care." 

(Adnkronos)