NEONATAL SEPSIS
A 3-week-old infant presents with irritability, poor feeding, temperature of
38.9°C (102°F), and grunting. Physical examination reveals a bulging
fontanel, delayed capillary refill, and grunting.
Signs and symptoms are very nonspecific.
Risk factors
Prematurity
Chorioamnionitis
Intrapartum fever
Prolonged rupture of membranes
Most common organisms: group B Streptococcus, E. coli, and Listeria
monocytogenes
Diagnosis—sepsis workup: CBC, differential and platelets, blood culture,
urine analysis and culture, chest x-ray; lumbar puncture only for neonates
with severe signs (lethargy, hypothermia, hypotonia, poor perfusion, apnea,
abnormal neurological findings, or clinical deterioration from birth)
Treatment
If no evidence of meningitis: ampicillin and aminoglycoside until 48–
72-hour cultures are negative
If meningitis or diagnosis is possible: ampicillin and thirdgeneration cephalosporin (not ceftriaxone)