Neonatal sepsis (neonatal septicemia or sepsis neonatorum) is a systemic condition that arises from a bacterial, viral, or fungal origin, is associated with hemodynamic changes and clinical findings, and causes severe morbidity and mortality (Bulbul, 2020). Neonatal sepsis may be categorized into three:
Early-onset Sepsis
Early-onset sepsis describes cases where clinical manifestations occur in the first three days of life (<72 hours). Of newborns with early-onset sepsis, 85% are present within 24 hours. Early-onset sepsis is associated with vertical transmission or acquisition of microorganisms from the mother. Infection can occur via hematogenous, transplacental spread from an infected mother. Organisms that colonize the mother’s genitourinary tract may be acquired by the neonate as it passes through the colonized birth canal at delivery (Gollehon & Aslam, 2019).
Late-onset Sepsis
Late-onset sepsis occurs at 4-90 days of life and is acquired from the environment. The infant’s skin, respiratory tract, conjunctivae, gastrointestinal tract, and umbilicus may become colonized via contact with the environment or caregivers.
Very Late-onset Sepsis
Very late-onset sepsis describes sepsis cases diagnosed in infants who are hospitalized in the neonatal intensive care unit from the first 30 days of life until discharge (Bulbul, 2020).
The most important risk factor causing sepsis development in the neonatal period is premature birth and low birth weight. Premature babies with low birth weight have a risk of developing sepsis three to ten times higher than full-term babies with normal birth weight.
Premature babies with low birth weight have a risk of developing sepsis three to ten times higher than full-term babies with normal birth weight
In addition, low levels of transplacental maternal IgG levels in preterm babies are among the risk factors. Chorioamnionitis, premature rupture of membranes (>18 hours), intrapartum maternal fever (>38℃), delivery earlier than 37 weeks of gestation, maternal group B streptococcal (GBS) colonization, and other conditions that increase the risk of GBS infection in the newborn increases the risk of early neonatal sepsis (Bulbul, 2020).
Nursing Care Plans
Here are eight (8) neonatal sepsis nursing care plans and nursing diagnoses:
- Risk for Ineffective Thermoregulation
- Risk for Fluid Volume Deficit
- Risk for Ineffective Tissue Perfusion
- Interrupted Breastfeeding
- Risk for Impaired Parent/Infant Attachment
- Risk for Unstable Blood Glucose Levels
- Ineffective Breathing Pattern
- Risk for Infection
Risk for Ineffective Thermoregulation
Temperature instability is observed with neonatal sepsis and meningitis, either in response to pyrogens secreted by the bacterial organisms or from sympathetic nervous system instability. The neonate is most likely to be hypothermic. When infants are hypothermic or are not kept in a neutral thermal environment, efforts to regulate body temperature can cause metabolic acidosis (Gollehon & Aslam, 2019).
Nursing Diagnosis
- Risk for Ineffective Thermoregulation
Risk factors
- Lack of brown fat in preterm infants
- Immature heat-regulating center of the brain
- Excessive heat loss by radiation
- Increased metabolism
- Hypoglycemia
Possibly evidenced by
- Not applicable; (the presence of signs and symptoms establishes an actual diagnosis.)
Desired Outcomes
- The newborn will be able to maintain a normal body temperature.
- The newborn will avoid developing cold stress.
- The newborn will exhibit normal vital signs and Apgar score.
Nursing Assessment and Rationales
1. Monitor the newborn’s temperature.
The infant’s skin temperature will decrease before the core temperature falls. Therefore a skin probe is used to monitor the temperature of preterm infants. The skin probe is placed in the right upper quadrant of the abdomen. During the first day of life, a newborn’s temperature is usually taken and recorded every four to eight hours.
2. Perform an Apgar scoring.
Newborns are observed and rated according to an Apgar score at one minute and five minutes after birth. The newborn is considered vigorous if the initial scores are seven and above. If the five-minute score is less than seven, soring is done every five minutes thereafter until the score reaches seven. Heart rate, respiratory effort, muscle tone, reflex irritability, and color of the infant are each rated 0, 1, or 2.
Nursing Interventions and Rationales
1. Keep nursing care organized and prompt.
Perform all early newborn care speedily and expose the newborn to cool air as little as possible to conserve the little heat the newborn has. The temperature will fall almost immediately to below normal because of heat loss, the temperature of birthing rooms, and the infant’s immature temperature-regulating mechanisms if the newborn is not protected from heat loss at birth and in the moments afterward.
2. Place the newborn on the mother’s abdomen after birth.
Evaporation is the loss of heat through the conversion of a liquid to a vapor. Newborns are wet when born so that they can lose a great deal of heat as the amniotic fluid on their skin evaporates. To prevent this type of heat loss, lay the newborn on the mother’s abdomen immediately after birth and cover the newborn with a warm blanket for skin-to-skin contact.
3. Dry the newborn thoroughly after birth.
Drying the newborn- especially the face and hair– also effectively reduces evaporation because the head, which is a large surface area in a newborn, can be responsible for a great amount of heat loss.
4. Place the newborn under a radiant heat source or a radiant warmer or in an incubator.
Drying and placing the newborn under a radiant heat source is an excellent mechanical measure to help conserve heat or prevent heat loss. The newborn can also be placed under a radiant warmer or in an incubator to maintain a warm environment. The temperature of the incubator is adjusted so that the newborn’s body temperature is at an optimal level ( 36.2 to 37℃ [971. To 98.6℉).
5. Cover the newborn with warm blankets and a cap.
Covering the hair with a cap after drying further reduces the possibility of evaporation cooling. Cover the newborn with a warm blanket either when on top of the mother’s abdomen or when placed in a warm crib.
6. Cover surfaces where the newborn is placed with warm blankets.
Conduction is the transfer of body heat to a cooler solid object in contact with a newborn. Covering surfaces with a warmed blanket or towel is necessary to help minimize conduction heat loss.
7. Administer antibiotic therapy as indicated.
In the United States and Canada, the current approach to the treatment of early-onset neonatal sepsis includes the administration of combined intravenous aminoglycoside and expanded-spectrum penicillin antibiotic therapy. This regimen provides coverage for gram-positive organisms, especially group B Streptococcus (GBS), and gram-negative bacteria, such as E. coli.
Recommended Resources
Recommended nursing diagnosis and nursing care plan books and resources.
Disclosure: Included below are affiliate links from Amazon at no additional cost from you. We may earn a small commission from your purchase. For more information, check out our privacy policy.
- Nursing Care Plans: Nursing Diagnosis and Intervention (10th Edition)
An awesome book to help you create and customize effective nursing care plans. We highly recommend this book for its completeness and ease of use. - Nurse’s Pocket Guide: Diagnoses, Prioritized Interventions and Rationales
A quick-reference tool to easily select the appropriate nursing diagnosis to plan your patient’s care effectively. - NANDA International Nursing Diagnoses: Definitions & Classification, 2021-2023 (12th Edition)
The official and definitive guide to nursing diagnoses as reviewed and approved by the NANDA-I. This book focuses on the nursing diagnostic labels, their defining characteristics, and risk factors – this does not include nursing interventions and rationales. - Nursing Diagnosis Handbook, 12th Edition Revised Reprint with 2021-2023 NANDA-I® Updates
Another great nursing care plan resource that is updated to include the recent NANDA-I updates. - Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5(TM))
Useful for creating nursing care plans related to mental health and psychiatric nursing. - Ulrich & Canale’s Nursing Care Planning Guides, 8th Edition
Claims to have the most in-depth care plans of any nursing care planning book. Includes 31 detailed nursing diagnosis care plans and 63 disease/disorder care plans. - Maternal Newborn Nursing Care Plans (3rd Edition)
If you’re looking for specific care plans related to maternal and newborn nursing care, this book is for you. - Nursing Diagnosis Manual: Planning, Individualizing, and Documenting Client Care (7th Edition)
An easy-to-use nursing care plan book that is updated with the latest diagnosis from NANDA-I 2021-2023. - All-in-One Nursing Care Planning Resource: Medical-Surgical, Pediatric, Maternity, and Psychiatric-Mental Health (5th Edition)
Definitely an all-in-one resources for nursing care planning. It has over 100 care plans for different nursing topics.
See also
Other recommended site resources for this nursing care plan:
- Nursing Care Plans (NCP): Ultimate Guide and Database MUST READ!
Over 150+ nursing care plans for different diseases and conditions. Includes our easy-to-follow guide on how to create nursing care plans from scratch. - Nursing Diagnosis Guide and List: All You Need to Know to Master Diagnosing
Our comprehensive guide on how to create and write diagnostic labels. Includes detailed nursing care plan guides for common nursing diagnostic labels.
Other care plans related to the care of the pregnant mother and her baby:
- Abortion (Termination of Pregnancy) | 8 Care Plans
- Cervical Insufficiency (Premature Dilation of the Cervix) | 4 Care Plans
- Cesarean Birth | 11 Care Plans
- Cleft Palate and Cleft Lip | 7 Care Plans
- Gestational Diabetes Mellitus | 8 Care Plans
- Hyperbilirubinemia (Jaundice) | 4 Care Plans
- Labor Stages, Induced, Augmented, Dysfunctional, Precipitous Labor | 45 Care Plans
- Neonatal Sepsis | 8 Care Plans
- Perinatal Loss (Miscarriage, Stillbirth) | 6 Care Plans
- Placental Abruption | 4 Care Plans
- Placenta Previa | 4 Care Plans
- Postpartum Hemorrhage | 8 Care Plans
- Postpartum Thrombophlebitis | 5 Care Plans
- Prenatal Hemorrhage (Bleeding in Pregnancy) | 9 Care Plans
- Preeclampsia and Gestational Hypertension | 6 Care Plans
- Prenatal Infection | 5 Care Plans
- Preterm Labor | 7 Care Plans
- Puerperal & Postpartum Infections | 5 Care Plans
- Substance Abuse in Pregnancy | 9 Care Plans
References and Sources
Recommended journals, books, and other interesting materials to help you learn more about neonatal sepsis nursing care plans and nursing diagnosis:
- Abramowski, A., Ward, R., & Hamdan, A. H. (2021, September 9). Neonatal Hypoglycemia – StatPearls. NCBI. Retrieved September 12, 2022.
- Adnyana, M. L. D., Sanjaya, G. N., Sukmawati, M., Purniti, N. P. S., Subanada, I. B., & Gustawan, I. W. (2021, February 10). Mortality of Neonatal Sepsis with Abnormal Blood Glucose Level. American Journal of Pediatrics, 7(1), 9-13.
- Akech, S., Rotich, B., Chepkirui, M., Ayieko, P., Irimu, G., & English, M. (2018, January 09). The Prevalence and Management of Dehydration amongst Neonatal Admissions to General Paediatric Wards in Kenya—A Clinical Audit. Journal of Tropical Pediatrics, 64(6), 516-522.
- Ambalavanan, N., & Nimavat, D. J. (2018, October 18). Fluid, Electrolyte, and Nutrition Management of the Newborn: Overview, Prevalence and Loss of Body Water, Assessing Fluid and Electrolyte Status. Medscape Reference. Retrieved September 12, 2022.
- Bokhari, A. M., & Stuart, M. (2019, February 5). Bacterial Sepsis: Practice Essentials, Background, Etiology. Medscape Reference. Retrieved September 12, 2022.
- Bulbul, A. (2020, June 12). Neonatal Sepsis – PMC. NCBI. Retrieved September 8, 2022.
- Chang, C.-J., Chi, H., Jim, W.-T., Chiu, N.-C., & Chang, L. (2022, February 10). Risk of infection in neonates born in accidental out-of-hospital deliveries. PLOS One, 17(2).
- Coskun, D., & Gunay, U. (2020, January-February). The Effects of Kangaroo Care Applied by Turkish Mothers who Have Premature Babies and Cannot Breastfeed on Their Stress Levels and Amount of Milk Production. Journal of Pediatric Nursing, 50, e26-e32. https://doi.org/10.1016/j.pedn.2019.09.028
- Daglas, M., Sidiropoulou, C., Galanis, P., Bilali, A., Antoniou, E., & Iatrakis, G. (2020, January-April). Maternal and Neonatal Factors Associated with Successful Breastfeeding in Preterm Infants. International Journal of Caring Sciences, 13(1).
- Gollehon, N. S., & Aslam, M. (2019, June 13). Neonatal Sepsis: Background, Pathophysiology, Etiology. Medscape Reference. Retrieved September 8, 2022.
- Joynt, C., & Cheung, P.-Y. (2018, April 13). Treating Hypotension in Preterm Neonates With Vasoactive Medications. NCBI. Retrieved September 12, 2022.
- Wynn, J. L., & Wong, H. R. (2011, June 01). Pathophysiology and Treatment of Septic Shock in Neonates. Clinical Perinatology, 37(2), 439-479.
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