Intended for healthcare professionals

Practice Easily Missed?

Neonatal sepsis

BMJ 2020; 371 doi: (Published 01 October 2020) Cite this as: BMJ 2020;371:m3672
  1. Faith Kim, neonatal-perinatal medicine fellow1,
  2. Richard A Polin, professor of pediatrics1,
  3. Thomas A Hooven, assistant professor of pediatrics2
  1. 1Department of Pediatrics, Columbia University Vagelos College of Physicians and Surgeons, NY, USA
  2. 2Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
  1. Correspondence to TA Hooven thomas.hooven{at}

What you need to know

  • The most common early signs of sepsis in infants are fever or hypothermia, tachypnoea, lethargy, or new parental reports of poor feeding. Consider sepsis in infants with an apparent change in mental status, tone, or perfusion as well

  • Neonatal sepsis can present with subtle signs but can rapidly progress to multisystem organ failure and meningitis, which carry high mortality and morbidity rates. Refer infants in whom sepsis is suspected to an emergency department for evaluation

  • Although non-specific tests such as a complete blood count and inflammatory markers are often obtained in the initial assessment, the most important test is a blood culture with at least 1 mL of blood, drawn before administering antibiotics

A 10 day old, full term baby is referred to the emergency department by his paediatrician for tachypnoea and decreased breastfeeding. He was born by uncomplicated vaginal delivery and was discharged home after an uneventful stay in the hospital nursery. Mother and baby established breastfeeding easily and he had been feeding well, every two to three hours. However, since around midnight, his mother reports him as sleepy and difficult to feed. He has had no urine output for six hours. His paediatrician reported tachypnoea with a respiratory rate of 80 breaths per minute and nasal flaring. His blood glucose was 55 mg/dL (3 mmol/L), and he had a rectal temperature of 36.5°C. In the emergency department, he receives a lumbar puncture and has a blood culture drawn, and he is started on ampicillin and ceftriaxone. Eleven hours later, his blood culture returns positive for Streptococcus agalactiae (group B Streptococcus, or GBS).

What is neonatal sepsis?

Neonatal sepsis, or illness caused by systemic bacterial infection, is a major cause of paediatric morbidity and mortality. The 2015 Global Burden of Disease study identified neonatal sepsis as the third most common cause of newborn …

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