Neonatal sepsis: diagnostic tests and initial treatment
THE CONTEXT
Management of neonatal sepsis requires prompt antibiotics and equally important supportive care.
Diagnostic tests
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Procalcitonin (PCT)* is a calcitonin precursor produced by thyroid C cells and is an acute phase reactant. Serum PCT is not helpful in diagnosing neonatal sepsis.
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Molecular tests that amplify bacterial DNA, such as polymerase chain reaction, have been used as add-on tests to improve diagnostic accuracy.
Treatment priorities
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Supportive care and antibiotics are equally important. Antibiotics take at least 12–24 hours to show an effect, so optimal supportive care is essential.
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In a seriously sick neonate with suspected sepsis, obtain blood samples for culture and initiate appropriate antibiotics without delay.
Temperature, breathing, and perfusion
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Provide warmth and maintain a temperature of 36.5–37.5°C.
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Give oxygen by hood or mask for cyanosis or grunting, and provide bag and mask ventilation for inadequate breathing. Normal saline nasal drops may help clear nasal blockage.
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Assess perfusion using peripheral pulses, capillary refill time, skin color, and serial urine output. Normal capillary refill time is less than 2–3 seconds.
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For poor perfusion, infuse normal saline or Ringer lactate 10 mL/kg over 5–10 minutes. If perfusion remains poor, repeat the same infusion 1–2 times over the next 30–45 minutes. Dopamine and dobutamine may be required.
Glucose, fluids, and nutrition
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Establish intravenous access. If hypoglycemia is suspected, give 10% glucose 2 mL/kg immediately; glucose boluses should not be used routinely.
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Provide maintenance fluid, electrolytes, and glucose at 4–6 mg/kg/min. Add potassium only after normal urine flow is documented.
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Initiate enteral feeding early when the neonate is hemodynamically stable and has no abdominal distension. Use mother's milk.