Escobar et al reported clinical categories for a neonate >= 34 weeks of gestation. This can help to guide clinical management. The authors are from Kaiser Permanente, Brigham and WOmen's Hospital, University of California San Francisco, Harvard Medical School, Beth Israel-Deaconess Medical Center and University of California Santa Cruz.

Neonate: >= 34 weeks of gestation


Categories during the first 12 hours after delivery:

(1) clinical illness

(2) equivocal presentation

(3) well-appearing


Clinical illness

(1) 5 minute Apgar < 5

(2) one or more of the following:

(2a) received nasal continuous positive airway pressure or mechanical ventilation

(2b) received continuous infusion of vasoactive drug

(2c) had clinical seizure

(2d) significant respiratory distress (nasal flaring, grunting, retractions)

(3) received supplemental oxygen within the first 6 hours


Equivocal presentation involves >= 2 instances with one or more of the following:

(1) heart rate >= 160 beats per minute

(2) respiratory rate >= 60 breaths per minute

(3) temperature < 97.5°F or >= 100.4 °F

(4) respiratory distress (grunting, flaring, retracting)



An instance is the occurrence of a second abnormal value >= 2 ours after the first occurrence of an abnormal index value.

An instance is sign-specific (same abnormal measurement criteria met each episode).

Since the first episode triggers the evaluation, the number of instances is the number of episodes minus 1.


Well-appearing: any infant not in one of the other 2 categories in the first 12 hours after birth


Maternal risk factors for sepsis risk at birth were estimated:

(1) low (< 0.65 per 1000 live births)

(2) intermediate (0.65 to 1.54 per 1000 live births)

(3) high (>= 1.54 per 1000 live births)




continued observation

well-appearing and maternal risk low

observe and evaluate

equivocal and maternal risk low; well-appearing and maternal risk intermediate

treat empirically

all others


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