Ultimate NEET-PG Exam Study Material

Proven Effective Content with 96% Strike Rate

Neonatal Sepsis: Risk Factors, Clinical Features, Diagnosis & Treatment

Feb 23, 2023

Neonatal Sepsis

Neonatal sepsis is an important topic in Pediatrics for the NEET PG Exam because it is a serious and potentially life-threatening condition that requires early recognition and appropriate management. It is a significant cause of morbidity and mortality in the neonatal period, especially in premature or low-birth-weight infants.

In this blog we’ll cover the associated risk factors, clinical features, diagnosis and treatment of neonatal sepsis. Keep reading.

ENT Residency


A clinical syndrome characterized by signs and symptoms suggestive of systemic neonatal infection with or without bacteremia.

  • Classification
    • Early onset sepsis (EOS)
    • Late onset sepsis (LOS)

Early onset sepsis

  • Onset usually within within 1st 72 hrs. of life
  • Organisms responsible are usually derived from maternal genital tract like Group B streptococci, E.Coli.

Risk factors

  • Mother:
    • Foul smelling liquor 
    • Premature rupture of membranes (≥ 24 hours prior to delivery)
  • Delivery: 
    • Difficult/ prolonged labour (1st and 2nd stage duration > 24 hours)
    • Multiple Per-Vaginal examination (single nonsterile / ≥ 3 sterile examinations)   
  • Baby:
    • Low Birth Weight 
    • Prematurity 
    • Perinatal asphyxia

Late onset sepsis

  • Organisms acquired from environment   
  • Community acquired (baby staying at home)
    • Staphylococcus aureus 
    • E. coli 
  • Hospital Acquired (baby in hospital)
    • Acinetobacter 
    • Klebsiella 

NOTE: Meningitis is commonly associated with LOS

Risk Factors:                                          

Nosocomial Community acquired
Prematurity Poor hygiene
NICU admission Poor cord care
Invasive procedures Bottle feeding
Mechanical ventilation Lack of breastfeeding
Use of stock solutions Pre lacteal feeds    


  • Exclusive breastfeeding helps in prevention of neonatal sepsis.
  • Most Effective/ Important Method to Prevent Neonatal Sepsis   
  • Proper Hand Washing of Caregivers for At Least 2 Minutes (6 Steps)
NEONATAL SEPSIS : 6 steps of hand washing
6 Steps of Hand Washing


Most Common Organism Responsible for Neonatal Sepsis    

In IndiaAcinetobacter > klebsiella
In hospitals in IndiaAcinetobacter > klebsiella
In hospitals across the worldE. coli
Early onset sepsis (world)Group B- streptococcus
Overall throughout the worldGroup B- streptococcus

Clinical Features

  • Poor feeding or alteration in established feeding behavior (earliest manifestation)
  • Temperature disturbances (Hypothermia > fever)
  • Metabolic → Hypoglycemia, metabolic acidosis
    CNS Shrill cry, irritability, seizures, abnormal posturing
    Respiratory Tachypnea, hypoxia, respiratory distress
    GI Abdominal distension, feed intolerance 
  • Severe sepsis:
    • Septic shock 
    • Multiple organ dysfunction 
    • DIC: Bleeding
    • Sclerema: Generalized, non-pitting edema seen in neonates with severe sepsis/ severe hypothermia

Also Read: CARBOHYDRATE & Amino Acid Metabolism DISORDERS


Definitive Test (gold standard) → Blood Culture
Screening Test → Sepsis Screen 
Sepsis Screen
Components → Any 2 out of 4 → +ve sepsis screen 

  1. ANC (Absolute Neutrophil Count) → < 1800/mm3
    ANC cutoff
    For term neonates: Manroe’s charts
    For VLBW neonates: Mouzinho’s charts
  2. I-T ratio [Immature: Total neutrophil] → >0.2
  3. Micro ESR → >15 mm
  4. CRP [C-Reactive Protein] → > 1 mg/dl
  • Positive sepsis screen has:
    Sensitivity= 90-100%
    Specificity= 80%
    Positive predictive value=25%
    Negative predictive value=99-100%

Supportive Tests: 

  • Blood glucose
  • CXR 
  • Lumbar puncture & CSF study (in all cases of LOS and cases of EOS with neurological features) 


  • Supportive Care 
    • Shift to Nursery/ NICU
    • Start IV fluids
    • Maintain normal temperature (36.5- 37.5 degrees) 
    • Maintain euglycemia
    • Maintain normal oxygen saturation
  • Specific Treatment
    • I.V. broad Spectrum Empirical antibiotics
    • Indications


  • Foul smelling liquor
  • ≥ 3 risk factors for EOS
  • <3 risk factors +clinical features suggestive of neonatal sepsis and +ve sepsis screen
  • Strong clinical suspicion of EOS


  • +ve sepsis screen
  • Strong clinical suspicion

 Which antibiotics?

  • Inj. Ampicillin + inj. Gentamicin 
    Inj. Cefotaxime (3rd generation cephalosporin), if meningitis present or suspected 

Duration of antibiotic therapy

Sepsis screen Blood culture CSF S/O meningitis Duration of Antibiotics 
---3 days
+--1 week (7-10 days) 
±+/-++/--+2 weeks 3 weeks

Download the PrepLadder app if you have any questions or concerns about this subject and learn more from our in-depth video lectures and NEET PG Study material.

Rapid Revision 5.0
Auther Details

PrepLadder Medical

Get access to all the essential resources required to ace your medical exam Preparation. Stay updated with the latest news and developments in the medical exam, improve your Medical Exam preparation, and turn your dreams into a reality!


Top searching words

The most popular search terms used by aspirants

  • neet pg notes
  • neet pg pediatrics