SEPSIS IN NEONATES
CLASSIFICATION
Early-onset sepsis is usually defined
as illness during the first 3 days of life
(some define it as illness within first 7
days)
Late-onset sepsis is usually defined as
illness between days 4 and 30 of life
(some define it as illness between
days 7 and 30, whereas others define
it as illness earlier than 90-120 days of
life
 CLINICAL MANIFESTATION

• HISTORY

Temperature instability Tachypnea 

Evidence of peripartum fetal distress 
Hyperthermia / Hypothermia  Diminished tone/activity 
• Intrapartum fetal tachycardia 
Lethargy or irritability  Anorexia/poor feeding 
• Apgar score of 6 or lower at 5 minutes
Apnea, bradycardia, and cyanosis in Seizure-like activity 
• Meconium staining of amniotic fluid
preterm infants  Vomiting 
• Purulent amniotic fluid
Respiratory distress in full-term infants Diarrhea

History of maternal complications during delivery 

Associated with preterm birth and small infants 
Chorioamnionitis
Higher risk of infection is associated with gestational
Prolonged rupture of membranes (longer than 18 hours)
ages less than 37 weeks and neonatal weight less than
Maternal intrapartum fever
2500 g
Maternal urinary tract infection
 CLINICAL MANIFESTATION

• Physical examination findings can be nonspecific, but sepsis is unlikely in healthy-looking

neonates Hemodynamic decompensation
Respiratory changes are a common presenting clinical sign
of infection  Bradycardia
Dyspnea : Grunting / Flaring / Intercostal retractions  Tachycardia (more than 160 beats per minute)
Tachypnea (more than 60 breaths per minute) Hypotension 
Apnea Prolonged capillary refill time
Abdominal findings
Color changes:
Temperature instability Abdominal distention 
Cyanosis / Jaundice / Pallor
Hypothermia (<=35) Hepatomegaly
More common in preterm infants Skin finding :
Central nervous system findings
Hyperthermia (>=38) Petechiae
Altered level of alertness
More common in term infants Periumbilical
Lethargy
Serious bacterial infection is found in 12% to erythema
Irritability
28% of febrile neonates presenting to Granulomatosis
Hypotonia/weak suck 
emergency department  infantiseptica
Seizures
 DIAGNOSTIC PROCEDURE

•Any neonate with signs of sepsis requires full diagnostic evaluation 

• History and physical examination
• Most neonates with early-onset sepsis show abnormal clinical signs within first 24 hours after birth 
•Full diagnostic evaluation for bacterial sepsis includes
• Early-onset disease (first 72 hours of life)
• CBC and blood culture
• Cerebrospinal fluid analysis and culture
• Chest radiograph if any abnormal respiratory signs are present
• Tracheal aspirate testing, if intubated
• Late-onset disease (after 72 hours of life) 
• CBC and blood culture
• Cerebrospinal fluid analysis and culture
• Urinalysis with microscopy and urine culture
• Chest radiograph if any abnormal respiratory signs/symptoms are present or if reliable SaO₂ value is persistently less
than 95% 
• Tracheal aspirate testing, if intubated
• Stool bacterial culture in infants with diarrhea
• Cultures from any other potential area of focus, such as pustules or purulent ocular or umbilical drainage
 TREATMENT

Goals
Promptly identify infants with high likelihood of sepsis and start
antimicrobial therapy; provide supportive therapy

Any neonate with signs of sepsis requires full diagnostic evaluation, admission, antibiotic therapy, and inpatient
clinical monitoring pending culture results 
Typical empiric antibiotic choice for suspected sepsis
•Early-onset neonatal sepsis
• Ampicillin and gentamicin
•Late-onset neonatal sepsis
• Ampicillin and gentamicin or cefotaxime
Supportive therapy includes:
•Administer oxygen to maintain SaO₂ between 94% and 99% and provide respiratory support
•Use fluid resuscitation and vasopressors (dopamine/debutamine) to treat poor perfusion and hypotension
•Monitor to prevent hypoglycemia, electrolyte imbalances (eg, hypocalcemia), and metabolic acidosis
•Provide antipyretic for comfort (Acetaminophen)