Nitric oxide is thought to play an important role in the mediation of the cardiovascular features of septic shock. We determined plasma levels of nitrite and nitrate (not differentiated in measurement) in neonates with sepsis and found these levels to be elevated at the time of entry compared with those of control subjects (p < 0.05); the levels were significantly higher in the patients with sepsis and shock than in those without shock (p < 0.05). Elevations of nitrite plus nitrate were correlated with tumor necrosis factor and severity of illness judged by pediatric risk of mortality (PRISM) scores at onset (p < 0.05). Of 8 newborn infants with a nitrite-plus-nitrate value > 200 mumol/L, 6 had septic shock; none of 12 not reaching that cutoff value had septic shock (p < 0.05). Levels of nitrite plus nitrate were elevated as much in gram-positive as in gram-negative sepsis. We conclude that the determination of circulating plasma levels of nitrite plus nitrate may be useful in forecasting the severity of illness and the occurrence of septic shock; therapeutic approaches associated with inhibition of nitric oxide synthesis may be worth trying in infants with septic shock.