Neonatal Sepsis

Neonatal sepsis is a serious bloodstream infection occurring in the first 28 days of life. It can progress rapidly and is a leading cause of newborn death, making early recognition and urgent treatment essential.

• Poor feeding or refusal to feed
• Lethargy or reduced activity, or, conversely, irritability
• Fast or difficult breathing, or grunting
• Temperature instability — fever or low body temperature
• Poor colour (pallor, mottling, or blueness), or a bulging fontanelle in more severe cases
• Seizures in severe cases

• Can be acquired before birth, during delivery (from the mother's genital tract), or after birth from the environment or healthcare setting.
• Risk is increased by prolonged rupture of membranes before delivery, maternal infection during labour, prematurity, low birth weight, and unhygienic delivery or cord care practices.

• Diagnosis relies heavily on recognising the often subtle and non-specific early signs listed above in a newborn, since neonatal sepsis can progress rapidly and does not always present with obvious fever.
• Assessment includes a thorough examination for signs of infection, and, where available, blood tests and cultures to identify the causative organism.
• Risk factors from the pregnancy and delivery (such as prolonged rupture of membranes or maternal fever in labour) are considered alongside the newborn's clinical signs.

Any newborn with signs suggestive of sepsis should be treated as a medical emergency and referred urgently to a facility capable of inpatient newborn care.

Empirical intravenous antibiotics — typically a combination such as ampicillin (or benzylpenicillin) plus gentamicin — are started promptly once sepsis is suspected, without waiting for laboratory confirmation, and adjusted once more information is available.

Supportive care includes maintaining the newborn's temperature (keeping the baby warm), supporting feeding or providing fluids, and giving oxygen if there is breathing difficulty.

Close monitoring is essential, as the newborn's condition can change quickly; danger signs require immediate escalation of care.

• Ensure clean, hygienic delivery practices with a skilled birth attendant.
• Practise clean umbilical cord care after birth, keeping the stump clean and dry.
• Promote early and exclusive breastfeeding, which supports the newborn's immune defences.
• Ensure prompt treatment of any maternal infection during pregnancy or labour.
• Seek immediate care for any newborn who is feeding poorly, unusually sleepy, or breathing abnormally.