Synopsis
Recognise subtle neonatal infection, integrate maternal risk with clinical indicators, obtain cultures without delaying treatment, prescribe age- and setting-appropriate IV antibiotics, and review them at 36 or 48 hours using NICE criteria.
- Early-onset infection presents within 72 hours of birth in the NICE pathway and is commonly vertically acquired; late-onset infection begins from 72 hours onward.
- Neonatal sepsis is often nonspecific: altered behaviour, poor feeding, temperature instability, respiratory change, apnoea, jaundice, glucose instability or abdominal signs may precede collapse.
- Use NICE risk factors and clinical indicators systematically. Any red-flag indicator, or two or more non-red-flag factors or indicators, usually triggers investigation and empirical antibiotics.
Key red flags
Apnoea, grunting, increasing oxygen need, shock, mottling, poor perfusion or hypotension may be the only early sign of invasive infection.
Investigation priorities
Identify bacteraemia and guide narrow definitive treatment.
Confirm CNS infection and define organism and duration.
Management branches
The baby is within 72 hours of birth.
- Identify red flags and count other NICE risk factors and clinical indicators.
- With any red flag or at least two factors/indicators, culture and treat without waiting; with only one non-red-flag item, use clinical judgement and monitor for at least 12 hours if not treating.
Key medicines
Benzylpenicillin intravenousFor empirical early-onset infection, 25 mg/kg IV every 12 hours; consider every 8 hours when the newborn appears very ill. Pair with gentamicin and use the current neonatal formulary for gestation, age and renal modifiers.
Gentamicin intravenous5 mg/kg IV for empirical neonatal infection. NICE advises the second dose usually 36 hours later in early-onset treatment; all subsequent timing follows concentration monitoring, gestation, postnatal age, renal function and the neonatal formulary.