PE19.13-14 | Neonatal Sepsis — Summary & Reflection

KEY TAKEAWAYS

Neonatal sepsis presents with non-specific signs — poor feeding, temperature instability, lethargy, respiratory distress. It is classified as EOS (<72 hours, vertical transmission, GBS/E. coli/Listeria/Klebsiella, risk factors: prolonged ROM/chorioamnionitis) or LOS (>72 hours, nosocomial, CoNS/Staph. aureus/Klebsiella/Candida, risk: indwelling devices, prematurity). Diagnosis uses the NNF sepsis screen (≥3 of 5 criteria positive) plus blood culture (gold standard). Empirical treatment for EOS is ampicillin + gentamicin (weight-based); LOS requires anti-Staphylococcal cover (cloxacillin/vancomycin) ± antifungal if Candida risk. LP is mandatory if meningitis suspected. Perinatal TORCH infections (Toxoplasma, syphilis, rubella, CMV, HSV, HBV) cause congenital infection with hearing loss, chorioretinitis, calcifications, and cardiac defects — each has specific treatment (acyclovir for HSV, valganciclovir for CMV, penicillin for syphilis, HBIg + vaccine for HBV).

REFLECT

Return to the opening case: a 28-hour-old neonate, born after 22 hours of ruptured membranes, with hypothermia, tachypnoea, and poor feeding. You now recognise this as a classic EOS presentation with multiple risk factors — prolonged ROM, borderline preterm, temperature instability. You know the organisms to cover, the sepsis screen, and the antibiotic doses. Reflect: what features in this case would prompt you to also perform an LP? (Seizures, bulging fontanelle, deterioration despite initial antibiotic response.) How does the non-specific nature of neonatal sepsis create a diagnostic dilemma — how do you avoid over-treating every mildly irritable neonate, while not missing the sick baby who will die without antibiotics? The sepsis screen helps, but clinical judgement remains essential.