This handout is for neonatal early-onset sepsis (eos). Your care team identified this based on: neonate ≤72 h of life with tachypnea, grunting, retractions, or apnea — sepsis must be considered (puopolo 2018 pmid 30455342).
Other reasons your team may use this plan: neonate with temperature instability (hypothermia more common than fever in eos) (puopolo 2018 pmid 30455342); lethargy, poor feeding, hypotonia — non-specific but high-yield eos triggers (puopolo 2018 pmid 30455342); maternal intrapartum fever or chorioamnionitis — strong eos risk factor (puopolo 2018; kuzniewicz 2017 pmid 28241253).
Take these medications exactly as prescribed. Do not stop or change a dose without talking to your provider.
| Medication | Starting dose | How | When | What it does |
|---|---|---|---|---|
| ampicillin | ampicillin 50 mg/kg IV q8h (term, week 1) / q12h (preterm <34 wks PMA, week 1); meningitis dose 75-100 mg/kg/dose q6-8h | IV | q6-12h per GA + PMA band | Covers GBS, Listeria, susceptible E. coli; standard EOS empiric backbone (Neofax 2024; Puopolo 2018; AAP Red Book 2024-2027 ch. neonatal sepsis) |
| gentamicin | gentamicin 4 mg/kg IV q24h (term) / 4.5 mg/kg q36h (late-preterm 30-34 wks GA) / 5 mg/kg q48h (preterm <30 wks GA, week 1) | IV | q24-48h extended interval | Gram-negative synergy with ampicillin; extended-interval dosing per Neofax 2024 + Puopolo 2018; trough <2 mcg/mL avoids nephro/ototoxicity. Lactation: minimal transfer; compatible (Neofax 2024) |
| acyclovir | acyclovir 20 mg/kg IV q8h (term, week 1+); preterm <30 wks PMA: 20 mg/kg q12h | IV | q8-12h per GA + PMA | Empiric HSV cover when maternal HSV at delivery, infant vesicular rash, unexplained hepatitis, or CSF pleocytosis; AAP Red Book 2024-2027 ch. HSV neonatal |
| pathogen_directed_definitive_antibiotics | Per organism + susceptibilities at 36-72 h culture-finalisation; narrow ampicillin alone for GBS; cefotaxime for E. coli meningitis (AVOID ceftriaxone <28 d) | IV | per pathogen | Stewardship and pathogen-directed narrowing per Puopolo 2018 + IDSA principles; ceftriaxone-avoid-<28-d is hard safety rule (bilirubin displacement + Ca-IVF incompatibility) |
Plan: Neonatal EOS — empiric ampicillin + gentamicin; escalate per pathogen / clinical course (Puopolo 2018 PMID 30455342 / 30455344; Verani CDC 2010 PMID 21088663)
Pediatric follow-up within 24-48 h of discharge for high-risk; 1-week visit for all. Hearing screen (AABR) — sensorineural hearing loss is a sequela of bacterial meningitis. Neurodevelopmental peds at 6-12 mo for culture-positive meningitis or septic-shock survivors (Bayley III / ASQ-3). Immunization catch-up per ACIP schedule.
Guideline: Puopolo KM et al — AAP 2018 Management of Neonates ≥35 0/7 wk With Suspected/Proven EOS (Pediatrics 2018 PMID 30455342) + companion preterm ≤34 6/7 wk (PMID 30455344); Kaiser EOS calculator Kuzniewicz 2017 (JAMA Peds PMID 28241253) for risk-based observation; Verani CDC 2010 GBS Prevention Guidelines (MMWR PMID 21088663) for IAP framework.