1. Neonatal sepsis is a major cause of
morbidity and mortality.
2. Diagnostic tests for early-onset
sepsis (other than blood or CSF cultures)
are useful for identifying infants
with a low probability of sepsis
but not at identifying infants likely to
be infected.
3. One milliliter of blood drawn before
initiating antimicrobial therapy is
needed to adequately detect bacteremia
if a pediatric blood culture bottle
is used.
4. Cultures of superficial body sites,
gastric aspirates, and urine are of
no value in the diagnosis of earlyonset
sepsis.
5. Lumbar puncture is not needed in
all infants with suspected sepsis (especially
those who appear healthy)
but should be performed for infants
with signs of sepsis who can safely
undergo the procedure, for infants
with a positive blood culture, for infants
likely to be bacteremic (on the
basis of laboratory data), and infants
who do not respond to antimicrobial
therapy in the expected manner.
6. The optimal treatment of infants with
suspected early-onset sepsis is
broad-spectrum antimicrobial agents
(ampicillin and an aminoglycoside).
Once the pathogen is identified,
antimicrobial therapy should be
narrowed (unless synergism is
needed).
7. Antimicrobial therapy should be
discontinued at 48 hours in clinical
situations in which the probability
of sepsis is low.