Infection and Sepsis
Core concepts
Know early-onset versus late-onset neonatal sepsis: early-onset (within 72 hours) is often from maternal genital tract organisms (group B Streptococcus, E. coli), while late-onset is often nosocomial or community-acquired. Understand group B Streptococcus prophylaxis based on maternal screening and risk factors. Recognize sepsis signs in the newborn - temperature instability, lethargy, poor feeding, respiratory distress, apnea, jaundice - which are often subtle and nonspecific. Know the sepsis workup (blood culture, complete blood count, lumbar puncture when indicated) and the principle of empiric antibiotics after cultures. Understand maternal infections affecting the fetus: TORCH organisms, syphilis, HIV, and hepatitis B, including prevention strategies.
Traps
Questions test that a normal CBC does not exclude sepsis and that antibiotics should not be delayed for culture results in a symptomatic infant. Another trap: assuming fever is required - neonates may be hypothermic. Also beware confusing prophylaxis indications for GBS.
Worked example
A 12-hour-old infant has grunting, temperature instability, and lethargy. Rule of thumb: obtain cultures and start empiric antibiotics promptly - do not wait for results in a symptomatic neonate; reassess and narrow therapy when cultures are negative.
Study focus
Recognize subtle sepsis signs and know prevention and workup pathways.