The National Institute for Health and Care Excellence (NICE) has listed criteria for recognizing early-onset neonatal sepsis.


Patient selection: neonate


Early onset neonatal sepsis has an onset less than 72 hours after delivery.


Clinical Assessment


any red flag risk factor or finding

high level concern, consider antibiotic therapy

any other risk factor or finding

physical exam without delay


Red flag risk factors:

(1) parenteral antibiotic therapy to mother for invasive bacterial infection during 24 hours before and 24 hours after delivery (exclusion: prophylactic antibiotics)

(2) multiple pregnancy AND suspected/confirmed infection in one or more siblings


Other risk factors:

(1) invasive group B streptococcal infection in a previous pregnancy

(2) maternal group B streptococcal colonization, bacteriuria and/or infection during current pregnancy

(3) prelabor rupture of the membranes

(4) premature rupture of the membranes for > 18 hours AND preterm birth

(5) preterm birth (before 37 weeks gestation) following spontaneous labor

(6) intrapartum fever > 38°C OR chorioamnionitis confirmed/suspected


Red flag clinical indicators findings:

(1) respiratory distress starting > 4 hours after birth

(2) seizures

(3) need for mechanical ventilation in a term delivery

(4) signs of shock


Other clinical indicators/findings:

(1) altered behavior or responsiveness

(2) altered muscle tone, floppiness

(3) feeding difficulties

(4) feeding intolerance (vomiting, abdominal distension, excessive gastric aspirates)

(5) abnormal heart rate (bradycardia or tachycardia)

(6) signs of respiratory distress

(7) hypoxia (central cyanosis, reduced oxygen saturation)

(8) jaundice within 24 hours of delivery

(9) apnea

(10) signs of neonatal encephalopathy

(11) need for cardiopulmonary resuscitation

(12) need for mechanical ventilation in a preterm baby

(13) persistent pulmonary hypertension (persisten fetal circulation)

(14) abnormal body temperature (< 36°C, > 38°C) not explained by environmental factors

(15) unexplained coagulopathy (excessive bleeding, thrombocytopenia, INR > 2)

(16) oliguria lasting beyond 24 hours after birth

(17) hypoglycemia or hyperglycemia

(18) metabolic acidosis (base deficit >= 10 mmol/L)

(19) local signs of infection (eye, skin, other)

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