Neonatal Sepsis

A newborn with sepsis may not look dramatically ill at first. A small change in feeding, tone, temperature, breathing, colour, or responsiveness can be the earliest sign of a rapidly progressive infection. The immature neonatal immune response provides less neutrophil reserve, reduced chemotaxis and complement activity, and limited antibody protection in preterm infants; most transplacental maternal IgG is acquired after about 32 weeks' gestation. The timing and setting of infection provide the first clinical map. Early-onset sepsis (EOS) is bacterial sepsis occurring during the first 7 days of life, with most symptomatic cases appearing in the first 24 hours. It is usually acquired vertically from maternal genital tract flora. Late-onset sepsis (LOS) presents after that period and, in hospitalised preterm infants, is predominantly healthcare-associated or device-associated. A febrile infant up to 90 days of age also requires an age-based fever pathway; that pathway should not be confused with the EOS/LOS classification. For the RN, the central decision is not whether one isolated sign proves infection. It is whether a vulnerable infant has a pattern of deterioration that warrants immediate stabilisation,...