Sepsis in newborns.

1. Big picture

Neonatal sepsis is a life-threatening systemic infection in the first 28 days of life. The key exam message is simple:

A sick newborn is septic until proven otherwise.

Newborns rarely present like older children. They may have no fever, no localizing sign, and no obvious inflammatory focus. Instead, sepsis often presents as:

poor feeding + lethargy/irritability + temperature instability + respiratory distress/apnea + poor perfusion

Sepsis can rapidly progress to shock, disseminated intravascular coagulation, respiratory failure, meningitis, necrotizing enterocolitis, seizures, multiorgan failure, and death.