Neonatal Sepsis: Screening & Risk Stratification
Early identification of sepsis is vital. Clinical signs are often subtle, necessitating a high index of suspicion and structured screening, especially in infants with maternal or intrapartum risk factors.
1. Risk Factors for Early-Onset Sepsis
- Maternal: Prolonged rupture of membranes (> 18 hours), chorioamnionitis, maternal fever, or GBS colonization.
- Neonatal: Preterm birth, low birth weight, or Apgar score < 6 at 5 minutes.
2. Screening Parameters
| Test | Clinical Significance |
|---|---|
| CBC (with differential) | Look for neutropenia or absolute neutrophil count (ANC) abnormalities. |
| I/T Ratio | An immature-to-total neutrophil ratio > 0.2 is highly suggestive. |
| CRP/Procalcitonin | Acute phase reactants; serial measurements (at 12–24h) are more useful than a single value. |
| Blood Culture | Gold standard for definitive diagnosis. |
3. When to Start Antibiotics?
- If the infant is symptomatic, do not wait for lab results. Start empirical antibiotics (Ampicillin + Gentamicin) immediately after drawing blood cultures.
- If the infant is asymptomatic but has significant risk factors, perform a screening workup and monitor closely or start therapy based on institutional sepsis calculators.
NEET PG Hint: Remember that neutropenia is a more sensitive indicator of sepsis in the neonate than leukocytosis. If sepsis is suspected and the infant is deteriorating, ensure the CSF is sampled (if stable) to rule out meningitis, as up to 25% of neonates with sepsis may have associated meningitis.