Neonatal septic shock, a focus on first line interventions

Valentina Spaggiari; Erica Passini; Sara Crestani; Maria Federica Roversi; Luca  Bedetti; Katia Rossi; Laura Lucaccioni; Cecilia Baraldi; Elisa Della Casa Muttini; Licia Lugli; Lorenzo Iughetti; Alberto Berardi

doi:10.23750/abm.v93i3.12577

Neonatal septic shock, a focus on first line interventions

Authors

Valentina Spaggiari Pediatric Post-graduate School, University Hospital of Modena and Reggio Emilia, Modena, Italy
Erica Passini Pediatric Post-graduate School, University Hospital of Modena and Reggio Emilia, Modena, Italy
Sara Crestani Pediatric Post-graduate School, University Hospital of Modena and Reggio Emilia, Modena, Italy
Maria Federica Roversi Neonatal Intensive Care Unit, Women’s and Children’s Health Department, University Hospital of Modena, Modena, Italy
Luca Bedetti PhD Program in Clinical and Experimental Medicine, University of Modena and Reggio Emilia
Katia Rossi Neonatal Intensive Care Unit, Women’s and Children’s Health Department, University Hospital of Modena, Modena, Italy
Laura Lucaccioni Pediatrics, Women’s, and Children’s Health Department, University Hospital of Modena, Modena, Italy
Cecilia Baraldi Neonatal Intensive Care Unit, Women’s and Children’s Health Department, University Hospital of Modena, Modena, Italy
Elisa Della Casa Muttini Neonatal Intensive Care Unit, Women’s and Children’s Health Department, University Hospital of Modena, Modena, Italy
Licia Lugli Neonatal Intensive Care Unit, Women’s and Children’s Health Department, University Hospital of Modena, Modena, Italy
Lorenzo Iughetti Pediatrics, Women’s, and Children’s Health Department, University Hospital of Modena, Modena, Italy
Alberto Berardi Neonatal Intensive Care Unit, Women’s and Children’s Health Department, University Hospital of Modena, Modena, Italy

DOI: https://doi.org/10.23750/abm.v93i3.12577

Keywords:

sepsis, newborn, septic shock, hemodynamic support, antibiotics

Abstract

Septic shock is a main cause of morbidity and mortality in neonates. Septic shock evolves from compensated to uncompensated through 3 distinct phases. Prompt diagnosis is challenging, since neonatal septic shock may overlap with the physiological changes occurring at birth. The outcome of septic shock depends on a prompt recognition of symptoms and a strict adherence to cardiopulmonary resuscitation guidelines. Fluid administration plays a major role in the initial management of septic shock. If there is no response to volume filling, inotropes must be infused within one hour of onset (dopamine, dobutamine, adrenaline). Life-threatening infections require immediate and aggressive empiric use of antimicrobials. In the pediatric age, delay in antibiotic initiation for treating septic shock is associated with poor outcome and increased risk of mortality. There is a gap regarding first line interventions in neonatal septic shock. This review addresses initial interventions in the treatment of neonatal septic shock and discusses currently available evidences., These interventions may allow to improve the outcome if they are promptly carried out.

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