NEONATAL SEPSIS  

Neonatal sepsis is defined as bacteremia with systemic manifestation in the absence 

of other primary systemic problems during the first 28 days of life’ Neonatal sepsis 

can be divided into two subtypes:

1. Early onset sepsis
2. Late onset sepsis 

Early onset sepsis: Occurs within the first 72 hours of life. It is caused by organisms 

prevalent in the genital tract of the mother or in the labour room, which includes 

• mainly group B streptococci
• E coli
• Coagulase-negative Staphylococcus and 
• L. monocytogenes.

Majority of the neonates with early onset sepsis clinically manifest 

with respiratory distress due to intrauterine pneumonia. 

Early onset sepsis has usually fulminant course and high mortality. 

Late onset sepsis: The onset is delayed for a minimum of four days in most cases 

symptoms appear by the end of first week of life. About 2/3 cases of late onset 

septicemia are caused by gram negative bacilli while the rest are contributed by 

gram positive organisms. Meningitis is more frequent. 

Recognition of systemic sepsis signs are usually non-specific since other 

conditions cause similar clinical states (e.g., cardiac or respiratory failure, metabolic 

disorders)

Clinical features 

- Pallor, lethargy, jaundice, fever, hypothermia 

- temperature instability (note 1/3 of confirmed sepsis cases are normothermic) 

- hypoglycemia, increased respiratory rate, apnea, grunting, cyanosis 

- tachycardia, bradycardia episodes, poor perfusion, hypotension 

- petechiae, bleeding from puncture sites 

- poor feeding, vomiting, abdominal distension, feed intolerance 

- bilious aspirates/vomitus and loose stools 

- lethargy, irritability,seizures 

Any baby who is unwell must be considered at risk of sepsis and appropriate 

antibiotics commenced as soon as possible after taking cultures. Inability to obtain 

cultures should not delay administration of antibiotics. 

Investigations 

- Laboratory:-complete blood count, blood culture, CSF analysis and culture, 

urinalysis and culture, stool culture 

- Chest X-ray 

- Ultrasonography of the brain and CT-scan of the brain (in complicated 

meningitis).

 

Treatment 

Objectives 

- Alleviate symptoms 

- Avoid life-threatening complications 

- Prevent multi-organ failure 

Non pharmacologic 

- Maintenance of body temperature (Kangaroo mother care, radiant warmer, 

incubator) 

- Adequate calorie and fluid maintenance 

- Correction of associated metabolic abnormalities 

Pharmacologic 

Till the culture report is collected start with broad-spectrum antibiotics, which 

includes penicillin and Aminoglycoside. 

First line 

Ampicillin, 100mg /kg/day every 12 hours IV.for 10 days. 

PLUS 

Gentamicin, 5mg/kg /day IV Daily for 10 days