Recognising early onset neonatal sepsis: an essential step in appropriate antimicrobial use

J Infect. 2016 Jul 5;72 Suppl:S77-82. doi: 10.1016/j.jinf.2016.04.026. Epub 2016 May 21.


Early diagnosis and timely treatment of early onset neonatal sepsis (EOS) are essential to prevent life threatening complications. Subtle, nonspecific clinical presentation and low predictive values of biomarkers complicate early diagnosis. This uncertainty commonly results in unnecessary and prolonged empiric antibiotic treatment. Annually, approximately 395,000 neonates (7.9% of live term births) are treated for suspected EOS in the European Union, while the incidence of proven EOS varies between 0.01 and 0.53 per 1000 live births. Adherence to guidelines for the management of suspicion of EOS is poor. Pragmatic approaches to minimise overtreatment in neonates with suspected EOS, using combined stratified risk algorithms, based on maternal and perinatal risk factors, clinical characteristics of the neonate and sequential biomarkers are promising.

Keywords: Early onset neonatal sepsis; Guidelines; Neonatal infection; Neonates; Perinatal infections; Procalcitonin; Sepsis.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Algorithms
  • Anti-Bacterial Agents / adverse effects
  • Anti-Bacterial Agents / therapeutic use*
  • Biomarkers
  • Calcitonin / blood
  • European Union
  • Female
  • Guideline Adherence
  • Humans
  • Infant, Newborn
  • Neonatal Sepsis / complications
  • Neonatal Sepsis / diagnosis*
  • Neonatal Sepsis / drug therapy*
  • Neonatal Sepsis / epidemiology
  • Practice Guidelines as Topic
  • Pregnancy
  • Prescription Drug Overuse / prevention & control
  • Risk Factors


  • Anti-Bacterial Agents
  • Biomarkers
  • Calcitonin