Septic Shock in Neonates neonatology

Septic shock in neonates remains a major cause of morbidity and mortality worldwide, posing challenges in timely recognition and management. This lecture will provide an integrated case-based review of its clinical features, diagnostic approach, pathophysiology, and recent therapeutic recommendations. Neonates present with non-specific signs of sepsis―temperature instability, lethargy, poor perfusion, apnea, or feeding intolerance-making early recognition difficult. Progression to septic shock is defined by cardiovascular compromise with hypotension, tissue hypoperfusion, and metabolic acidosis. Case illustrations will emphasize subtle early indicators and the importance of structured sepsis screening. Pathophysiologically, septic shock represents a dysregulated host response leading to systemic inflammation, endothelial dysfunction, capillary leak, and impaired oxygen utilization. Both vasodilatory and myocardial depression components contribute to shock, necessitating tailored treatment. The diagnostic workup includes blood cultures, inflammatory biomarkers (CRP, procalcitonin), complete blood counts, coagulation profile, and lactate as a marker of perfusion. Point-of-care ultrasound (POCUS) is increasingly valuable for assessing cardiac function and guiding fluid management. Management prioritizes prompt antimicrobial therapy within the first hour, careful fluid resuscitation, and early hemodynamic support. Recent guidelines advocate cautious use of crystalloid boluses, particularly in resource-limited settings, to avoid fluid overload. The choice of vasoactive support has evolved: while dopamine was historically first-line, current evidence supports norepinephrine and epinephrine as preferred agents, guided by shock phenotype. Dobutamine may be useful in myocardial dysfunction, and hydrocortisone is considered in refractory shock. Adjunctive strategies such as immunoglobulins, antifungal prophylaxis, and novel biomarkers remain under investigation. This session will emphasize structured management pathways, integrating Surviving Sepsis Campaign ۲۰۲۳ recommendations with bedside case examples, to equip clinicians with updated strategies for early recognition and tailored therapy.

کلیدواژه ها:

neonatal sepsis ، septic shock ، norepinephrine ، vasopressors ، neonatal intensive care ، fluid resuscitation