Neonatal sepsis. Progress in diagnosis and management

Despite the rarity of proven neonatal bacterial sepsis (1 to 5 cases/1000 live births) systemic bacterial infections during the first month of life remain a major cause of morbidity and mortality. Most neonatal bacterial infections occur during the first week of life (early onset sepsis) and result from the spread of micro-organisms colonising the maternal genital tract into the amniotic cavity. Susceptible infants either inhale or swallow contaminated amniotic fluid and develop generalised sepsis. During the last decade, however, improvements in neonatal intensive care have permitted the survival of a population of very low birthweight infants, who remain hospitalised for many months, and who are at increased risk of developing nosocomial infections. The primary objective of the clinician caring for infants at risk for neonatal infection is to identify all potential cases of bacterial disease quickly and begin antibiotic therapy promptly. It is equally important, however, to determine which of these cases represent true infection, and therefore require a full course of antibiotics, and which do not. This paper reviews the epidemiology of bacterial infections in neonates, and critically evaluates current recommendations for the diagnosis and treatment of neonatal sepsis.