What is neonatal infection & sepsis?

Neonatal infection means a newborn has an illness caused by germs (bacteria, viruses, or fungi) most often during the first month of life. Infections can involve the bloodstream (sepsis), lungs (pneumonia), brain and spinal fluid (meningitis), urinary tract, or skin/umbilical cord.

Sepsis is the body’s overwhelming response to infection. It can cause low blood pressure, breathing problems, and organ dysfunction, and it can worsen quickly without prompt treatment.

Hospitals and clinicians are expected to:

1. Screen and stratify risk at birth (maternal history, labor details, GBS status, membrane rupture time).
2. Monitor closely (vitals, feeding, behavior) during the first 24–48 hours and beyond when risk is elevated.
3. Act on warning signs immediately with labs (blood culture, CBC, inflammatory markers), and start empiric antibiotics promptly when sepsis is suspected—often before labs return.
4. Escalate care (NICU transfer, fluids, respiratory support, glucose management) at the first signs of instability.
5. Reassess and de-escalate based on culture results and clinical course; perform lumbar puncture when meningitis is a concern.
6. Document and communicate clearly across shifts and teams, including discharge instructions and return precautions.

Why timing matters

Early-onset sepsis (EOS): usually birth–72 hours

• Often linked to labor/delivery factors such as maternal fever, infection of the amniotic fluid (chorioamnionitis), Group B Strep (GBS) without enough antibiotics in labor, or prolonged rupture of membranes (water broken a long time before delivery).
• Babies may show subtle signs at first (feeding poorly, low temperature) that can progress to breathing trouble, low blood sugar, or lethargy.

Late-onset sepsis (LOS): after 72 hours

• Watch for fever or low temp, sleepiness/irritability, poor feeding, color changes, breathing pauses (apnea), or seizures.
• More often related to hospital exposure (especially in the NICU), central lines/tubes, or community sources after discharge.

Common pathogens: Group B Streptococcus (GBS), E. coli, other gram-negative bacteria; in NICU settings, staph species and fungi can also be involved.

Red flags providers must not miss

• Temperature instability (too low or fever)
• Poor feeding, weak cry, lethargy or unusual irritability
• Fast breathing, grunting, apnea, color changes (pale/blue)
• Low blood sugar, poor perfusion, low blood pressure
• Seizures, bulging fontanelle (possible meningitis)
• Jaundice or abnormal lab results in context of infection risk

High-risk situations requiring heightened vigilance:

• Maternal fever, chorioamnionitis, or prolonged rupture of membranes
• GBS-positive status without adequate antibiotics in labor
• Prematurity or low birth weight
• Invasive lines (central lines), recent surgery, or NICU stays

Where care breaks down (and becomes a case)

• Delay in recognition: subtle symptoms written off as “normal newborn” behavior.
• Delay to antibiotics: waiting on labs rather than treating suspected sepsis.
• Failure to monitor: missed vitals, skipped checks, or inadequate observation after a maternal fever or GBS risk.
• Inadequate handoffs: critical risk information not communicated between L&D, nursery, and pediatrics.
• Device-related lapses: poor line care/infection control in the NICU.
• Unsafe discharge: sending a high-risk infant home without clear instructions or follow-up.

Injuries & Outcomes We See:

• Prolonged hospitalization/NICU stays
• Meningitis, brain injury, cerebral palsy, hearing/vision loss
• Respiratory failure, shock, multi-organ dysfunction
• Developmental delays, feeding and growth problems
• In the most tragic cases, wrongful death