Edward F. Bell, MD, Jonathan M. Klein, MD, Robert D. Roghair, MD
Peer Review Status: Internally Peer Reviewed 2012

Term or Preterm Infants with Clinical Signs of Sepsis

A sepsis work-up should be performed to include a CBC with differential, a blood culture and CSF for analysis and culture, and antibiotic therapy initiated. The infant should be reassessed at 48-72 hours.

Consideration can be given to discontinuing antibiotics if the clinical course has not been suggestive of infection, there are no maternal risk factors identified, (e.g., +GBS, chorioamnionitis), lab results are reassuring, e.g., normal I:T ratio on CBC, normal serial CRPs at 24-72 hours, and the infant’s cultures are negative. Be aware that the cultures may be negative if there was maternal pretreatment with intrapartum antibiotics.

If the infant’s cultures are positive, if signs of sepsis persist or strong maternal risk factors are identified, longer courses of antibiotics are warranted.

Term Infants without Clinical Signs of Sepsis with or without Pretreatment with Intrapartum Antibiotics

These infants should be closely observed without the need for cultures or antibiotics for 48 hours if they are asymptomatic. A screening CBC with differential should be obtained.

If the infant becomes symptomatic or if the CBC with differential has an I:T >15%, a sepsis work-up as outlined above should be performed. The length of antibiotic therapy will depend upon the clinical course, lab results, maternal risk factors and infant’s cultures.

Flow sheet for management decisions