Evaluation and treatment of a neonate for possible bacterial infection and sepsis is one of the most common pediatric practices. Signs and symptoms of sepsis in a neonate are quite broad and include respiratory distress, lethargy or irritability, fever or hypothermia, hypo- or hyperglycemia, acidosis, hypotonia, poor feeding apnea, cyanosis, seizures, poor perfusion, shock, unexplained jaundice, or simply “not looking well.” Ten percent of full-term babies with fever not due to environmental causes may have bacterial sepsis.

Because the neonate’s response to sepsis is generic and often confusing, a systematic approach that does not vary is important for assuring that all infants with potential sepsis are identified. Evaluation of a neonate with fever should include a complete history and physical. Laboratory investigations include a complete blood cell count with a white blood cell differential, blood culture, urine culture, and lumbar puncture. Other potentially useful tests may include a chest x-ray, C-reactive protein, erythrocyte sedimentation rate, and a bacterial antigen profile. Although the large proportion of septic workups in infants are negative, the method exists to assure that those babies with potentially devastating meningitis are identified and treated early. Treatment should begin as soon as possible and include antibiotics that cover organisms commonly found in the neonatal period, including group B streptococci and Escherichia coli.