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 in the Canadian Paediatric Society (CPS) definition, with most symptomatic cases appearing in the first 24 hours. Some surveillance systems and guidelines use the first 72 hours for EOS, so the cut-off depends on the document you are reading. EOS 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....