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Neonatal sepsis
Neonatal sepsis is split into early-onset (up to 72 hours, organisms from the mother: GBS, E. coli, Listeria) and late-onset (after 72 hours, organisms from the environment and the NICU), and the signs are usually non-specific — so treatment starts early on suspicion.
Why it matters in the exam
The exam shows a newborn who "does not look well": temperature instability (including hypothermia), lethargy, poor feeding, apnoea or respiratory distress. The candidate must recognise maternal risk factors, choose the right empirical treatment (ampicillin + gentamicin) and know why ceftriaxone is not given to newborns. Further questions deal with prevention: intrapartum antibiotics for the mother against GBS and what counts as "adequate" prophylaxis.
It is important to separate early from late onset: in the NICU, with central lines, late-onset sepsis is caused mainly by coagulase-negative staphylococci, so empirical treatment includes vancomycin. Every newborn with a positive blood culture or strong clinical suspicion has a lumbar puncture, because meningitis can occur without clear neurological signs. A blood culture that is negative after 36–48 hours in a well baby usually allows antibiotics to stop.
In the question, look for the maternal risk factors: prolonged rupture of membranes of 18 hours or more, maternal fever in labour or intra-amniotic infection, GBS carriage without adequate prophylaxis and preterm birth. When several are present together, even a well-looking newborn needs a structured assessment and observation. On the other hand, in a baby who looks unwell there is no waiting for results — treatment starts at once and is adjusted when the cultures return.
Key points
- Early-onset up to 72 hours: GBS, E. coli, Listeria; late-onset after 72 hours.
- Empirical treatment in the newborn: ampicillin + gentamicin.
- In the NICU with a central line: coagulase-negative staphylococci, hence vancomycin.
- A positive culture requires a lumbar puncture.
- No ceftriaxone in newborns; a negative culture at 36–48 hours allows antibiotics to stop.
Summary table
| Type | Onset | Main organisms | Empirical treatment |
|---|---|---|---|
| Early-onset (EOS) | Up to 72 hours | GBS, E. coli, Listeria | Ampicillin + gentamicin |
| Early-onset with suspected meningitis | Up to 72 hours | The same organisms | Ampicillin + a third-generation cephalosporin other than ceftriaxone (e.g. cefotaxime), at meningitic doses |
| Late-onset, community | After 72 hours and up to 3 months | Late GBS, E. coli, S. aureus | Ampicillin + cefotaxime (or gentamicin), according to the suspected source |
| Late-onset, NICU | After 72 hours, with a central line | Coagulase-negative staphylococci, S. aureus, Gram-negatives, Candida | Vancomycin + gentamicin, adjusted to cultures |
A free exam question
במשטח נרתיקי שבוצע באישה בהריון בשבוע 36 . צמחו חיידקים גראם חיוביים בשרשראות האם טופלה סביב הלידה בטיפול אנטיביוטי. איזו הסתמנות קלינית כתוצאה ממחולל זה עלולה להגרם בתינוק שנולד? (the question as examined, in Hebrew)
- א. לימפאדניטיס וצלוליטיס בגיל חודש
- ב. דלקת לחמית קשה בגיל 3 . ימים
- ג. ארטריטיס בגיל 4 . ימים
- ד. הפרשה מוגלתית ממושכת מהאף
In the full version for subscribers
- A simple algorithm
- Memory aid
- Exam traps
- 5 review cards
- Enough for IMLE
The full version is open to subscribers of: Pediatrics, Medical licensing exam (IMLE), Obstetrics and gynecology.
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Sources
- AAP Clinical Report: Management of Neonates Born at 35 0/7 or More Weeks' Gestation With Suspected or Proven Early-Onset Bacterial Sepsis, 2018 — Risk assessment approaches
- ACOG Committee Opinion: Prevention of Group B Streptococcal Early-Onset Disease in Newborns, 2020 — Screening and intrapartum prophylaxis
- Nelson Textbook of Pediatrics, 22nd edition (2024) — Infections of the Neonatal Infant
Sources are given for further reading; the text is written afresh and not copied from them.
Reviewed by the Examqo AI Professor · 2026-11-02. The text may contain errors; when in doubt, check the source.