Management of neonates with suspected or proven early-onset bacterial sepsis

Pediatrics. 2012 May;129(5):1006-15. doi: 10.1542/peds.2012-0541. Epub 2012 Apr 30.


With improved obstetrical management and evidence-based use of intrapartum antimicrobial therapy, early-onset neonatal sepsis is becoming less frequent. However, early-onset sepsis remains one of the most common causes of neonatal morbidity and mortality in the preterm population. The identification of neonates at risk for early-onset sepsis is frequently based on a constellation of perinatal risk factors that are neither sensitive nor specific. Furthermore, diagnostic tests for neonatal sepsis have a poor positive predictive accuracy. As a result, clinicians often treat well-appearing infants for extended periods of time, even when bacterial cultures are negative. The optimal treatment of infants with suspected early-onset sepsis is broad-spectrum antimicrobial agents (ampicillin and an aminoglycoside). Once a pathogen is identified, antimicrobial therapy should be narrowed (unless synergism is needed). Recent data suggest an association between prolonged empirical treatment of preterm infants (≥5 days) with broad-spectrum antibiotics and higher risks of late onset sepsis, necrotizing enterocolitis, and mortality. To reduce these risks, antimicrobial therapy should be discontinued at 48 hours in clinical situations in which the probability of sepsis is low. The purpose of this clinical report is to provide a practical and, when possible, evidence-based approach to the management of infants with suspected or proven early-onset sepsis.

MeSH terms

  • Anti-Bacterial Agents / adverse effects
  • Anti-Bacterial Agents / therapeutic use*
  • Bacteremia / diagnosis
  • Bacteremia / drug therapy*
  • Bacteremia / etiology
  • Bacteriological Techniques
  • Cooperative Behavior
  • Drug Administration Schedule
  • Evidence-Based Medicine
  • Female
  • Gestational Age
  • Humans
  • Infant, Newborn
  • Infant, Premature, Diseases / drug therapy*
  • Interdisciplinary Communication
  • Microbial Sensitivity Tests
  • Pregnancy
  • Risk Factors
  • Sepsis / diagnosis
  • Sepsis / etiology
  • Sepsis / therapy*


  • Anti-Bacterial Agents