Reference — Neonatal
Neonatal Sepsis Quick Reference
The septic newborn rarely looks dramatic — the signs are subtle and spread across every system. This is the fast recall: who’s at risk, what to watch for, what the workup includes, and how to prevent the late-onset case.
Educational use only. Risk stratification, workup, and antibiotic choices follow neonatology guidance and your facility’s protocol (including EOS risk calculators) — this is a recall aid, not an order set. This material supports nursing education and exam review. It is not medical advice and is not a substitute for clinical judgment, institutional policy, or medical direction. Always follow facility protocols and current provider orders.
Risk Factors
Maternal / early-onset
GBS colonization (esp. inadequate intrapartum antibiotics), chorioamnionitis or maternal fever, prolonged ROM ≥18 h, preterm labor, maternal UTI
Infant / late-onset
Prematurity and low birth weight, central lines, mechanical ventilation, prolonged hospitalization, invasive procedures
Signs by System
| System | Findings |
|---|---|
| Temperature | Instability — HYPOthermia often more than fever |
| Feeding/GI | Poor feeding, vomiting, abdominal distension, feeding residuals, jaundice |
| Respiratory | Apnea, tachypnea, grunting, flaring, retractions, increased O₂ need |
| Cardiovascular | Tachycardia or bradycardia, hypotension, mottling, poor perfusion, delayed cap refill |
| Neuro/behavior | Lethargy, irritability, hypotonia, ‘not acting right,’ seizures (late) |
| Metabolic | Hypoglycemia or hyperglycemia, metabolic acidosis |
Workup & Treatment
Workup: blood culture (before antibiotics), CBC with differential (I:T ratio), CRP/procalcitonin trends, glucose; urine culture and lumbar puncture depending on age and picture; chest film if respiratory signs.
Empiric antibiotics: ampicillin + gentamicin for early-onset (add/adjust coverage for late-onset and suspected meningitis per protocol). Give the first dose urgently after cultures; monitor gentamicin levels and renal function.
Stopping: negative cultures at 36–48 h with a well-appearing infant typically end empiric therapy.
Prevention Bundle
Hand hygiene before and after every contact — the single biggest lever against late-onset sepsis. Add central-line bundle compliance, minimizing line days and entries, meticulous skin and cord care, breast milk feeding when possible, and intrapartum GBS prophylaxis on the maternal side.
NCLEX Pearls
- ✦Hypothermia, poor feeding, lethargy, and apnea — not high fever — are the classic newborn sepsis flags.
- ✦Early-onset = maternal (GBS, E. coli; ROM ≥18 h, chorioamnionitis); late-onset = environment and lines.
- ✦Blood culture BEFORE the first antibiotic dose; ampicillin + gentamicin empirically.
- ✦Hand hygiene is the #1 prevention for late-onset sepsis.
- ✦A rectal temp ≥100.4°F (38°C) in an infant <1 month is an emergency workup.
Related Resources
Standards & sources
Fact-checked Jun 21, 2026This page is written to align with American Academy of Pediatrics (AAP) · Neonatal Resuscitation Program (NRP) · AWHONN. It is an educational summary, not a citation of any single document — always verify specific doses, values, and protocols against current guidelines and your facility policy. How we source content →