Bacterial Sepsis in the Neonate

Introduction Bacterial sepsis in the neonate is a significant cause of morbidity and mortality. More than half of all admissions to a neonatal intensive care unit (NICU) are for infants with or who are at risk of developing sepsis. Diagnosis is challenging since clinical signs are non-specific, supportive rapid screening laboratory assays lack good positive predictive value (PPV), and the entity carries a high mortality rate. As a result, a conservative approach to these patients has evolved, with many infants who are not septic receiving antibiotics. This chapter will discuss the epidemiology, diagnosis, treatment, and prevention of neonatal sepsis. Meningitis accompanies sepsis in approximately one-quarter of cases of neonatal disease, and thus the two processes share a common etiology and pathogenesis. This chapter will cover only bacterial sepsis of the term infant, since meningitis is covered elsewhere (Chapter 31). Further, prematurity and residence in an intensive care unit are independent risk factors for bacterial sepsis that differ from sepsis in the term infant, and these will not be considered here. In addition, the emphasis of this chapter will be on early-onset neonatal disease, with less of a concentration on late-onset sepsis.