Evaluating suspected sepsis in term neonates

Term newborns commonly undergo evaluations to ‘rule out sepsis’, although the frequency of this practice is unknown. Consequences may include increased duration of hospitalisation, admission to the neonatal unit and mother-infant separation, with interrupted breastfeeding. Newborn infants delivered ≥ 37 weeks gestation without congenital anomalies that had blood cultures performed in January and February 2008 were audited. Sepsis-associated maternal, perinatal and neonatal parameters were collected to classify each infant as having definite, clinical, or no sepsis. 54 of 944 term infants (5.7%) had blood cultures taken to rule out sepsis: 43 (80%) were negative, 11 (20%) had clinical sepsis and none had definite sepsis (3 had contaminants). The majority of evaluations were undertaken in the neonatal unit (59%) or the postnatal ward (34%), with respiratory distress the most frequent indication (38%). Infants with clinical sepsis were more likely to receive resuscitation at birth and to be admitted to the neonatal unit. Of all infants evaluated, 3 received antibiotics for longer than indicated, 1 had antibiotics discontinued early and one infant had antibiotics prescribed that were not optimal. ‘Rule out sepsis’ evaluations are common. Clinical guidelines together with ongoing education and vigilance regarding blood culture collection as well as choice and duration of antibiotics are important.