When the Immune System’s First Fight Isn’t Fair: Newborn Infections
“Congratulations! You have a healthy baby!” These are the words expectant parents hope to hear from a medical professional after the birth of their baby.
Unfortunately, not all new parents will receive this message. Some families are impacted by complications, which arise during the birthing process. For others, medical conditions can develop during the neonatal period (the first four weeks following birth) that can result in long-term injury, disability or death.
Most new parents are told that any fever during the first 12 weeks requires a medical consultation. This is because bacterial, viral, fungal and parasitic infections are one of the leading causes of infant mortality in Canada. Tragically, some of the poor outcomes related to these infections can be prevented by proper screening and follow-up care – this is particularly important when a newborn is considered at a higher risk for infection.
In this blog post, I will discuss common neonatal infections, explain how medical negligence can result in delayed or incorrect treatment, and how this can ultimately lead to a poor outcome for the infant.
Infant Mortality, Morbidity and Disability in Canada.
Between 1980 and 2021, Canada’s infant mortality rate significantly improved - dropping from approximately 10.9 deaths to 4.4 deaths out of every 1,000 births. Despite this improvement, Canada’s infant mortality rate has not kept pace with other wealthy nations. Experts in health policy suggest poverty, systemic racism and a fraying social safety net have all contributed to Canada’s worsening position among developed nations.
Congenital disease, complications in pregnancy, labour and delivery, and sepsis are each among the leading causes of infant mortality in Canada. Viral and bacterial infections can lead to sepsis, which can result in infant death. Delayed diagnosis and inadequate treatment can contribute to poor outcomes for the infants who survive.
Despite receiving some protective antibodies from the birth parent, while in utero and during the neonatal period (first four weeks of life), an infant’s immune system is less developed and can have difficulty combatting an infection - particularly if a child is born prematurely or has other risk factors such as low birth weight, fetal distress or prolonged NICU stay. Generally, any infant who is unwell is at increased risk of infection and ultimately sepsis.
Screenings for high-risk infants with prompt identification and treatment of these infections can reduce the risk of poor outcomes.
Common Types of In-Utero and Neonatal Infections.
There are many pathogens capable of causing an infection during pregnancy, delivery or in the neonatal period.
Common sources of infection include:
Viral: Hepatitis B virus (HBV), Hepatitis C virus (HCV), Severe Acute Respiratory Syndrome-Coronavirus-2 (SARS-CoV-2), herpes simplex virus (HSV), Human Immunodeficiency Virus (HIV), Varicella-Zoster Virus (VZV), Congenital Cytomegalovirus (CMV), enterovirus, or par echovirus
Bacterial: Streptococcus bacertias, E. coli, Listeria, N. gonorrhoeae, C. trachomatis, Treponema pallidum (Syphilis), Haemophilus influenzae, Neisseria meningitidis
Fungal: Candida
Parasites: Toxoplasma gondii
Common infections and related conditions include:
Neonatal sepsis
Early onset (within seven days of birth and most infants present within 24 hours of birth) or late onset (uncommonly associated with birth risk factors but risk increases with invasive procedures)
Can be caused by bacteria (commonly Group B Streptococcus (GBS), E. coli, Listeria,) viruses (commonly herpes simplex virus, enterovirus, parechovirus) or fungi (Candida)
Frequently observed clinical signs include respiratory distress, fever, temperature instability, tachycardia, jaundice, and poor feeding
Bacterial Meningitis
Presents similarly to sepsis, with common clinical signs including: temperature instability, lethargy, seizures, irritability, apnea, vomiting and respiratory distress
GBS, E. coli, and Listeria are the most common bacterial cause
Urinary Tract Infections
Presents similarly to sepsis
E. coli among common bacterial causes
Ophthalmia Neonatorum
Neonatal conjunctivitis is most often caused by bacteria
Infections caused by N. gonorrhoeae and C. trachomatis may cause vision loss
Encephalitis
Most often viral or bacterial
Fever, headache and sensitivity to light are common symptoms
Long-Term Effects of Newborn Infections.
An infection acquired in utero, during delivery, or immediately after birth can be life-threatening for an infant. Even when the newborn survives the infection, significant disability can result.
Depending on the type of infection, concurrent medical issues/conditions, and the speed at which the infant receives effective treatment, these type of illness may result in:
a long-term oxygen requirement
hearing and/or vision loss
seizures
Cerebral Palsy
cognitive impairment
physical impairment
speech impairment
behavioural problems
malformation of organs
immune-deficiencies or abnormalities (including multisystem inflammatory syndrome)
other neurological complications and poor neurodevelopmental outcomes
Was Your Child’s Injury Preventable?
Sadly, there are times when a newborn’s infection can result death or permanent disability even when medical providers do everything right.
It is also important to remember that medical providers are not expected to be perfect. There are times when they make clinical judgement calls that end up being wrong but were made with the information available at the time. If they acted commensurate with a professional of comparable education and experience faced with a similar circumstance, they will not be held liable for your child’s injury.
Doctors, nurses, lab technicians and other health care providers can be held liable for harm suffered by your newborn if their action or inaction does not meet the standard of care and caused or contributed to an injury. A few examples include: failure to recognize signs of infection or sepsis, failure to choose the appropriate antibiotic or an inadequate dosing of antibiotics. Another example may be unnecessarily exposing the infant to a pathogen; however, this can be incredibly difficult to prove.
Determining whether the standard of care has been breached and whether the error caused injury is a complex task that involves consultation with medical experts.
Parents may hear “sometimes these things just happen”. While this statement is factually accurate, it does not apply to every case.
A serious neonatal injury can change an infant’s entire life and result in tremendous impact to the infant’s family. If someone’s negligent actions caused or contributed to that injury, they should help share the burden of the costs in order to provide the best possible care available.
Some injuries don’t fully reveal themselves until months or even years later. As children grow and develop, they may begin to demonstrate unexplained neurological or physical conditions that may be linked to an infection they experienced around the time of birth or shortly thereafter. It is important to remind parents that they are not out of time! Timelines for claims involving children do not begin to run until they are 18 years of age.
