Internal Medicine

Neonatal sepsis (NNS)

Bacterial bloodstream infection (BSI) (eg. meningitis, pneumonia, pyelonephritis, or gastroenteritis) in the setting of fever.

Bacterial bloodstream infection (BSI) (eg. meningitis, pneumonia, pyelonephritis, or gastroenteritis) in the setting of fever.

  • M/imp cause of neonatal death in hospital as well as community in developing country


Early-onset sepsis (EOS): Less than 72 hr

Predominantly presents as pneumonia
  • LBW babies
  • Prolonged rupture of membranes (PROM)
  • Foul smelling liquor
  • Multiple par vaginum examinations
  • Maternal fever
  • Difficult/prolonged labour
  • Aspiration of meconium

Late-onset sepsis (LOS): After 72 hr

Presents as septicemia/pneumonia/meningitis
  • Lack of breastfeeding
  • Poor cord care
  • Superficial infections (eg. pyoderma, umbilical sepsis)
  • Aspiration of feeds
  • Disruption of skin integrity with needle pricks
  • Use of IV fluids

Causative organisms:

  • Commonly: E. coli, Staphylococcus aureus and Klebsiella sp.
  • Hospital-acquired infections:
    • Acinetobacter, Pseudomonas and coagulase-negative Staphylococci


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Clinical features


Overwhelming infection without much localization
  • Refuses to suck
  • Lethargic/unresponsive
  • Poor cry
  • Hypothermia
  • Abdominal distension
  • Vomiting
  • Diarrhoea (rare)
  • Apneic spells

Neonatal pneumonia:

Predominantly localized to the lung
  • Fast breathing
  • Chest retractions
  • Grunt

Neonatal meningitis:

Predominantly localized to the meninges
  • Excessive/high-pitched crying
  • Fever
  • Seizures
  • Blank look
  • Neck retraction
  • Bulging anterior fontanel


Neonatal sepsis screening:

Confirmatory if two parameters are positive:
  1. Total leukocyte count (TLC; <5000/mm3)
  2. Absolute neutrophil count (ANC; <1800/mm3)
  3. Immature to total neutrophil ratio (I/T ratio; > 20%)
  4. CRP (> 1 mg/ dl)
  5. Micro ESR (‚Č• 15 mm in the first hour)

CSF culture:

  • Enterococcus spp.
  • GBS
  • Klebsiella pneumoniae

Blood culture:

  • Klebsiella pneumoniae


Supportive management:

  • Warmth to baby
  • Oxygen by hood/mask (cyanosis/grunting)
  • Bag & mask ventilation (inadequate breathing)
  • Dopamine/dobutamine¬†(inadequate perfusion)
  • IV Glucose (hypoglycemia)
  • Optimal nutrition
  • IM Vitamin K IM (1 mg)
  • Transfuse packed cells

Empirical antimicrobial therapy

When aetiological agent unknown
Clinical situationSepticaemia and pneumonia Meningitis
Community-acquired; resistant strains unlikelyAmpicillin or Penicillin and Gentamicin (1st line)Cefotaxime and gentamicin
Hospital-acquired or low-moderate probability of  resistant strainsAmpicillin or Cloxacillin and Amikacin (2nd  line)Cefotaxime and amikacin
Hospital-acquired sepsis or high probability of resistant strainsCefotaxime and amikacin (3rd line)Cefotaxime and amikacin

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