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id.neonatal-sepsis.early-late.v1PRODUCTION
id.neonatal-sepsis.early-late.v1

Neonatal sepsis — early-onset (< 72 h) + late-onset (72 h - 28 d)

pediatricsacuteneonatal
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12/12 authored

Canonical 12-phase frame with authored status for this dossier.

Current phase

Frame

Detailed

Partition neonatal sepsis by hour-of-life: early-onset < 72 h (vertical-maternal pathogens — GBS / E. coli / Listeria) vs late-onset 72 h - 28 d (nosocomial — CoNS / MRSA / Klebsiella / Pseudomonas / Candida). Phoenix criteria 2024 explicitly exclude < 18 d; use AAP Puopolo 2018 framework.

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Onset partition assigned + gestational-age cohort tagged

Patient inputs (26)

Preterm < 32 wk vs late-preterm 32-36 wk vs term ≥ 37 wk drives gentamicin extended-interval dosing + EOS pretest probability (AAP Puopolo 2018)

Weight-based dosing for all neonatal drugs (mg/kg, mL/kg); VLBW < 1500 g cohort drives higher LOS + Candida risk (Stoll 2011)

Tachycardia > 180 OR bradycardia < 100 (terminal sign) in neonate per age-appropriate thresholds

Tachypnea > 60 OR apnoea in neonate; respiratory distress recognition (AAP Puopolo 2018)

Hypoxaemia in neonate; pre/post-ductal differential if structural concern; drives O2 + intubation decision

GBS-positive antepartum screen with inadequate IAP (< 4 h before delivery OR none given) drives newborn pathway per AAP Puopolo 2018 + CDC Verani 2010

Intrapartum maternal fever + clinical chorioamnionitis is the highest-LR maternal risk factor for EOS (AAP Puopolo 2018)

Prolonged ROM > 18 h is a CDC IAP indication + AAP EOS risk factor

Maternal genital HSV at delivery → neonatal HSV LR+ ~ 6; empiric acyclovir if neonate has any feature (Kimberlin 2013)

PICC / umbilical line / surgical drain in NICU → differential time-to-positivity + CLABSI workup (Mermel IDSA 2009)

TPN + broad-spectrum antibiotics > 5-7 d in preterm → candidemia risk (Cantey 2018)

Hour-of-life cutoff at 72 h partitions early-onset vs late-onset sepsis (AAP Puopolo 2018)

CBC with absolute neutrophil count using age-dependent reference (Manroe / Mouzinho curves); WBC < 5K or > 20K is an EOS marker (AAP Puopolo 2018)

≥ 1 mL minimum per bottle (Schelonka 1996); some centres draw × 2 from different sites; positive culture at 36-48 h LR+ > 100

LP at clinical concern OR culture-positive OR persistent clinical deterioration; CSF pleocytosis + protein + glucose + culture + HSV PCR if ≤ 28 d (AAP Puopolo 2018; Kimberlin 2013)

Hypoglycaemia < 47 mg/dL in neonate is dangerous + a sepsis-marker (AAP); D10W 2-3 mL/kg bolus then GIR 6-8 mg/kg/min

Thrombocytopenia < 100K is sepsis / DIC / NEC / candidemia marker; declining trend in preterm raises Candida suspicion

Hypothermia < 36 °C OR fever ≥ 38 °C rectal in neonate is a sepsis criterion (AAP Puopolo 2018); hypothermia in preterm is concerning for sepsis

Hypotension in neonate by gestational-age threshold (rough rule: SBP < gestational age in wk for first 24 h) drives vasoactive (AAP Puopolo 2018)

KUB for NEC evaluation — pneumatosis intestinalis (bell stage II) + pneumoperitoneum (bell stage III, surgical emergency)

CXR if respiratory distress; differentiates RDS, TTN, congenital pneumonia, pneumothorax

Catheterized urine specimen; UTI is rare in EOS but increases in LOS especially with urinary anomalies

CRP at 24 + 48 h informative pair (serial trend > single value); CRP > 10 mg/L LR+ ~ 3-5 (AAP Puopolo 2018)

Age-adjusted PCT thresholds (physiological peak 24 h post-birth); PCT > 2 ng/mL at 24-48 h LR+ ~ 3-5 (AAP Puopolo 2018)

Lactate > 4 mmol/L in neonate suggests perfusion failure; serial trend for resuscitation response

ALT/AST > 100 supports disseminated HSV; baseline for vancomycin / acyclovir nephrotoxicity monitoring

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Severity triggers (9)

9 need judgement
  • informationallife_threateningearly_onset_sepsis_within_72h_of_life
    Neonate < 72 h of life with sepsis features (temperature instability, poor feeding, lethargy, apnoea, hypoglycaemia, respiratory distress, hypotension) OR culture-positive blood / CSF — life-threatening early-onset sepsis per AAP Puopolo 2018
    Trigger could not be auto-evaluated — needs clinician judgement.
  • informationallife_threateninghsv_features_neonate
    Neonate ≤ 28 d with vesicles / seizures / hypothermia / unexplained transaminitis (ALT/AST > 100) / encephalopathy / maternal genital HSV — neonatal HSV until excluded (Kimberlin Pediatrics 2013 AAP Red Book 2024)
    Trigger could not be auto-evaluated — needs clinician judgement.
  • informationallife_threateninglate_onset_sepsis_at_72h_to_28d
    Neonate 72 h - 28 d with sepsis features (new-onset apnoea, lethargy, poor feeding, hypotension, thrombocytopenia, line-associated source) — life-threatening late-onset sepsis per AAP late-onset clinical-report series
    Trigger could not be auto-evaluated — needs clinician judgement.
  • informationallife_threateningnecrotizing_enterocolitis_bell_stage_2_3
    Preterm neonate with abdominal distention + bloody stools + thrombocytopenia + pneumatosis intestinalis on KUB (bell stage II) OR pneumoperitoneum / portal venous gas (bell stage III) — life-threatening NEC + sepsis coinfection (Walsh & Kliegman 1986 modified Bell staging)
    Trigger could not be auto-evaluated — needs clinician judgement.
  • informationallife_threateningcandidemia_in_neonate
    Preterm (< 32 wk OR < 1500 g) + TPN + broad-abx + thrombocytopenia + persistent fever despite antibacterial cover OR positive Candida blood culture — life-threatening neonatal candidemia (IDSA candidiasis 2016 Pappas)
    Trigger could not be auto-evaluated — needs clinician judgement.
  • informationallife_threateningmeningitis_confirmed_in_neonate
    CSF pleocytosis ≥ 20 WBC/µL + protein ≥ 100 mg/dL + glucose ratio < 0.5 OR positive CSF Gram stain / culture in neonate ≤ 28 d — life-threatening neonatal bacterial meningitis (IDSA bacterial meningitis 2024)
    Trigger could not be auto-evaluated — needs clinician judgement.
  • informationalsevereculture_negative_clinical_sepsis_rule_out
    Neonate with empiric antibiotics × 48-72 h + cultures negative + normal clinical course + normalising labs (CRP trending down, CBC normal) — antimicrobial stewardship "rule-out" course per Cantey 2018
    Trigger could not be auto-evaluated — needs clinician judgement.
  • informationalseveregbs_positive_mother_no_intrapartum_prophylaxis
    GBS-positive antepartum screen + inadequate intrapartum prophylaxis (no IAP OR < 4 h before delivery OR penicillin-allergic with non-GBS-targeted abx) — newborn risk-stratification per Kaiser EOS calculator (Escobar 2014 PMID 24379228) OR AAP categorical pathway
    Trigger could not be auto-evaluated — needs clinician judgement.
  • informationalseverepreterm_with_prolonged_antibiotic_exposure
    Preterm neonate (< 32 wk OR < 1500 g) with > 5-7 d empiric antibiotic exposure + negative cultures — increases NEC + late-onset sepsis + mortality (Cantey 2016 + Cantey 2018)
    Trigger could not be auto-evaluated — needs clinician judgement.

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Recommended regimen

Neonatal sepsis empiric antibiotics — by onset (early < 72 h vs late 72 h - 28 d) + comorbidity
axis: neonatal_sepsis_empirics_by_onsetstep early_onset_under_72h - Early-onset sepsis (< 72 h) — cover GBS, E. coli, Listeria
Selected step "Early-onset sepsis (< 72 h) — cover GBS, E. coli, Listeria" — Neonate < 72 h of life with suspected sepsis OR maternal intrapartum risk factor with clinical concern
  • ampicillin
    first line
    aminopenicillin
    200 mg/kg/day divided q8h (DOL 0-7) or q6h (DOL > 7); meningitis dose: 300 mg/kg/day divided q6-8h • IV • q6-8h
    triggers: eos_recognition
    Covers Listeria (cephalosporins do not) + GBS + sensitive E. coli (AAP Puopolo 2018)
    rxcui 733
  • gentamicin
    first line
    aminoglycoside
    Term ≥ 35 wk: 4 mg/kg q24h; late-preterm 30-34 wk: 4.5 mg/kg q36h; preterm < 30 wk: 5 mg/kg q48h (extended interval per gestational age) • IV • q24-48h extended interval
    triggers: eos_recognition, no_suspected_meningitis
    Gram-negative synergy with ampicillin; extended-interval dosing per Neofax + AAP Puopolo 2018; trough monitoring before 3rd dose
    rxcui 1596450
  • cefotaxime
    first line
    cephalosporin_3rd
    50 mg/kg/dose IV q8-12h (gestational + chronological-age dependent); meningitis: 50 mg/kg q6-8h • IV • q6-12h
    triggers: suspected_meningitis, gentamicin_unavailable_or_renal_dysfunction
    CNS penetration superior to gentamicin; use INSTEAD OF gentamicin if meningitis suspected. AVOID ceftriaxone in neonates < 28 d (bilirubin displacement + calcium-IVF interaction) (AAP Puopolo 2018; FDA 2009)
    rxcui 2186
  • acyclovir
    add on
    antiviral_nucleoside_analog
    60 mg/kg/day divided q8h IV (20 mg/kg/dose) for ≥ 35 wk; reduced interval q12h if preterm < 35 wk • IV • q8h (q12h preterm)
    triggers: hsv_features_neonate, age_le_28d_with_csf_pleocytosis_or_hepatitis, maternal_genital_hsv
    Cover neonatal HSV until excluded; high mortality if missed (Kimberlin Pediatrics 2013 AAP Red Book 2024). Duration: 14-21 d SEM; 21 d CNS/disseminated; suppressive PO acyclovir × 6 mo post-treatment for CNS disease (Kimberlin NEJM 2011)
    rxcui 281
  • vancomycin
    add on
    glycopeptide
    15 mg/kg/dose IV; interval per gestational + chronological age (q6h-q18h) • IV • per nomogram
    triggers: mrsa_risk, cons_risk_central_line, severe_sepsis_with_skin_or_line_source
    Add-on for MRSA / CoNS / severe SSTI source; AUC target 400-600 (Rybak IDSA 2020) with caveat — limited neonatal data
    rxcui 11124

outpatient playbook — drug actions (4)

  1. 1. IV-to-PO antibiotic continuation if course ongoing at discharge
    Pathogen-specific PO step-down (rare in neonate) • PO • per agent
    trigger: Discharge with antibiotic course incomplete (rare in neonate)
    Most neonatal courses complete inpatient; rare outpatient continuation
  2. 2. suppressive PO acyclovir × 6 months if neonatal HSV CNS or disseminated
    300 mg/m² PO TID × 6 months • PO • TID
    trigger: Treated neonatal HSV CNS or disseminated disease post-completion of IV induction
    Improves neurodevelopmental outcome (Kimberlin NEJM 2011)
  3. 3. PCV15 or PCV20 + Hib at age-appropriate timing
    Per ACIP age-based schedule • IM • per ACIP
    trigger: Age 2 months (after neonatal period ends)
    AAP Red Book 2024 + ACIP standard schedule; sepsis history does not modify schedule
  4. 4. influenza + COVID-19 vaccines for family contacts
    Per ACIP age-based schedule • IM • annual / per ACIP
    trigger: Every post-sepsis follow-up visit during season for family contacts
    Reduce future respiratory-source sepsis risk + protect neonate via cocooning

Auto-drafted A&P note

outpatient

Subjective

- Possible entry pathways: Neonate (≤ 28 d) with temperature instability (T < 36 °C or ≥ 38 °C rectal), poor feeding, lethargy, apnoea, hypoglycaemia, jaundice progression, or respiratory distress (AAP Puopolo 2018); Maternal risk factor: GBS-positive without intrapartum prophylaxis OR chorioamnionitis OR PROM > 18 h OR preterm < 37 wk OR intrapartum maternal temperature ≥ 38 °C (CDC Verani 2010 PMID 21088663; AAP Puopolo 2018); Preterm neonate < 32 wk gestation in NICU with new-onset clinical deterioration — late-onset sepsis high-pretest cohort (Stoll NICHD 2011 PMID 21873694).

Objective

- No vitals, labs, or imaging entered for this encounter.

Assessment

**Neonatal sepsis — early-onset (< 72 h) + late-onset (72 h - 28 d)** (id.neonatal-sepsis.early-late.v1).
Phenotype framing: Non-infectious mimics: transient tachypnea of newborn (TTN), respiratory distress syndrome (RDS), congenital cardiac disease (PPHN, ductal-dependent lesions, total anomalous pulmonary venous return), inborn errors of metabolism (hyperammonaemia, organic acidaemias), neonatal hypoglycaemia, hypothyroidism, polycythaemia, NEC primary (without sepsis), congenital adrenal hyperplasia. HSV without bacterial coinfection. Viral (enterovirus, parechovirus). Coexistence pairs: sepsis + AKI, sepsis + DIC, sepsis + NEC, sepsis + intraventricular hemorrhage (IVH).
Scope: Partition neonatal sepsis by hour-of-life: early-onset < 72 h (vertical-maternal pathogens — GBS / E. coli / Listeria) vs late-onset 72 h - 28 d (nosocomial — CoNS / MRSA / Klebsiella / Pseudomonas / Candida). Phoenix criteria 2024 explicitly exclude < 18 d; use AAP Puopolo 2018 framework.

No severity triggers fired against current inputs.

Plan

Regimen axis: **Neonatal sepsis empiric antibiotics — by onset (early < 72 h vs late 72 h - 28 d) + comorbidity** — step "Early-onset sepsis (< 72 h) — cover GBS, E. coli, Listeria".
1. ampicillin 200 mg/kg/day divided q8h (DOL 0-7) or q6h (DOL > 7); meningitis dose: 300 mg/kg/day divided q6-8h IV q6-8h (aminopenicillin, first line) — Covers Listeria (cephalosporins do not) + GBS + sensitive E. coli (AAP Puopolo 2018)
2. gentamicin Term ≥ 35 wk: 4 mg/kg q24h; late-preterm 30-34 wk: 4.5 mg/kg q36h; preterm < 30 wk: 5 mg/kg q48h (extended interval per gestational age) IV q24-48h extended interval (aminoglycoside, first line) — Gram-negative synergy with ampicillin; extended-interval dosing per Neofax + AAP Puopolo 2018; trough monitoring before 3rd dose
3. cefotaxime 50 mg/kg/dose IV q8-12h (gestational + chronological-age dependent); meningitis: 50 mg/kg q6-8h IV q6-12h (cephalosporin_3rd, first line) — CNS penetration superior to gentamicin; use INSTEAD OF gentamicin if meningitis suspected. AVOID ceftriaxone in neonates < 28 d (bilirubin displacement + calcium-IVF interaction) (AAP Puopolo 2018; FDA 2009)
4. acyclovir 60 mg/kg/day divided q8h IV (20 mg/kg/dose) for ≥ 35 wk; reduced interval q12h if preterm < 35 wk IV q8h (q12h preterm) (antiviral_nucleoside_analog, add on) — Cover neonatal HSV until excluded; high mortality if missed (Kimberlin Pediatrics 2013 AAP Red Book 2024). Duration: 14-21 d SEM; 21 d CNS/disseminated; suppressive PO acyclovir × 6 mo post-treatment for CNS disease (Kimberlin NEJM 2011)
5. vancomycin 15 mg/kg/dose IV; interval per gestational + chronological age (q6h-q18h) IV per nomogram (glycopeptide, add on) — Add-on for MRSA / CoNS / severe SSTI source; AUC target 400-600 (Rybak IDSA 2020) with caveat — limited neonatal data

Setting playbook (outpatient) — Post-discharge primary-care follow-up + developmental + immunization tracking + family education; high-risk neonatal sepsis survivors need close surveillance for neurodevelopmental sequelae especially if meningitis / HSV / preterm precipitant
6. IV-to-PO antibiotic continuation if course ongoing at discharge Pathogen-specific PO step-down (rare in neonate) PO per agent — Discharge with antibiotic course incomplete (rare in neonate) (Most neonatal courses complete inpatient; rare outpatient continuation)
7. suppressive PO acyclovir × 6 months if neonatal HSV CNS or disseminated 300 mg/m² PO TID × 6 months PO TID — Treated neonatal HSV CNS or disseminated disease post-completion of IV induction (Improves neurodevelopmental outcome (Kimberlin NEJM 2011))
8. PCV15 or PCV20 + Hib at age-appropriate timing Per ACIP age-based schedule IM per ACIP — Age 2 months (after neonatal period ends) (AAP Red Book 2024 + ACIP standard schedule; sepsis history does not modify schedule)
9. influenza + COVID-19 vaccines for family contacts Per ACIP age-based schedule IM annual / per ACIP — Every post-sepsis follow-up visit during season for family contacts (Reduce future respiratory-source sepsis risk + protect neonate via cocooning)

Non-pharmacologic actions:
- Physical therapy referral if functional decline / muscle tone abnormalities (especially preterm)
- Occupational therapy referral if fine-motor / ADL development concerns
- Speech / language therapy if speech delay post-CNS sepsis or dysphagia
- Developmental peds referral if Bayley / ASQ delays > 1 SD below mean
- Audiology + ENT if hearing loss confirmed (early intervention essential)
- Lactation continued support if breastfeeding
- Family adherence support + psychosocial barrier identification + social work if resource gaps
- Family CPR / infant safety + return precautions reinforcement

AVOID / contraindication checks:
- Ceftriaxone avoid under 28 days bilirubin displacement calcium ivf (AAP Puopolo 2018; FDA 2009)
- Gentamicin extended interval by gestational age neonate (AAP Puopolo 2018; Neofax)
- Fluoroquinolone avoid neonate unless no alternative (AAP Red Book 2024)
- Vancomycin AUC target not trough (Rybak IDSA 2020 PMID 32191793 with caveat — limited neonatal calibration)
- Acyclovir IV hydration prevent crystal nephropathy (Kimberlin 2013; AAP Red Book 2024)
- Cefotaxime preferred over ceftriaxone neonate (AAP Puopolo 2018)
- Dopamine vs epinephrine neonatal shock individualized (Subhedar Cochrane neonatal vasopressor reviews)
- Fluid bolus 10 to 20 mL per kg slower in neonate (AAP neonatal specific adaptation of SSC peds 2020)

Monitoring

Regimen monitoring:
- CBC + CRP at 24 + 48 h (serial trend more informative than single value in neonate)
- blood culture follow-up at 24 + 48 h (AAP Puopolo 2018)
- gentamicin trough before 3rd dose target < 2 mcg/mL (Neofax)
- vancomycin AUC q48-72h (or trough if AUC unavailable, target 15-20)
- BUN + creatinine + urine output q24h while on acyclovir (Kimberlin 2013)
- echocardiogram if S. aureus bacteremia persistent or line-positive
- repeat LP at end of meningitis treatment course
- daily reassessment of antibiotic + duration with goal de-escalation by 48-72 h if cultures negative (Cantey 2018 stewardship)

Setting (outpatient) monitoring:
- Peds visit at 24-48 h, 1 wk, 1 mo, 3 mo, 6 mo, 12 mo, then per standard schedule
- Neurodevelopmental re-assessment at 6 mo + 12 mo + 24 mo if precipitant was meningitis / HSV / preterm
- Family mental health re-screen at 3 mo + 6 mo + 12 mo
- Immunization status audit at every visit until catch-up complete
- Source-specific surveillance per cause

Follow-up plan: Outpatient peds visit within 24-48 h of discharge for high-risk; 1-week visit for all; growth + feeding tracking + developmental milestones; immunization catch-up per cause (PCV / Hib not yet age-eligible at < 28 d but tracked for first dose); hearing screen if meningitis (AABR + audiology referral); developmental peds referral at 6-12 mo if functional decline / neurological sequelae; family education on return precautions; vaccination of family contacts (Tdap, influenza, COVID-19 per ACIP); breastfeeding support; PT/OT if neurological sequelae; PICS-p / PICU-Family syndrome screening at 1-3 months for caregivers + child.
- Close-out criterion: Outpatient plan documented; follow-up scheduled; family education delivered

Monitoring phase: Vitals q4h (q1h initially in ill neonate), feeds + UOP + weight daily, lactate trend q2-4h until normalised, CBC + CRP at 24 + 48 h, blood culture follow-up at 24 + 48 h, vancomycin / gentamicin levels per pharmacy (trough or AUC), echocardiogram if line-positive S. aureus or persistent positive cultures, repeat LP at end of treatment for meningitis, daily reassessment of antibiotic + duration with goal de-escalation by 48-72 h if cultures negative (Cantey 2018 stewardship); developmental + feeding follow-up.

Disposition

Current setting: outpatient — Post-discharge primary-care follow-up + developmental + immunization tracking + family education; high-risk neonatal sepsis survivors need close surveillance for neurodevelopmental sequelae especially if meningitis / HSV / preterm precipitant

Disposition criteria:
- Sustained recovery — growth at age-appropriate baseline, neurodevelopmental assessments within age-appropriate range, immunization catch-up complete, family demonstrating return-precaution knowledge, no recurrent serious infection in 12 mo

Escalation triggers (move to higher acuity):
- New fever > 38 °C OR recurrent symptoms within 4 weeks of discharge → return to ED, blood culture, source-directed workup
- New focal neurological signs OR seizures → urgent neuro + neuroimaging
- Feeding intolerance + weight loss + bilious emesis → urgent peds + GI evaluation for late NEC / post-NEC stricture
- Hearing loss confirmed on audiology → ENT + audiology + speech + early intervention
- Family caregiver PHQ-9 ≥ 15 OR EPDS elevated → mental-health urgent referral
- Suspected immunodeficiency (≥ 2 serious infections in 12 mo OR unusual pathogen recurrence) → clinical immunology referral

Earlier-Return Triggers

Return-precaution thresholds (watch for):
- [LIFE_THREATENING] Neonate < 72 h of life with sepsis features (temperature instability, poor feeding, lethargy, apnoea, hypoglycaemia, respiratory distress, hypotension) OR culture-positive blood / CSF — life-threatening early-onset sepsis per AAP Puopolo 2018
- [LIFE_THREATENING] Neonate ≤ 28 d with vesicles / seizures / hypothermia / unexplained transaminitis (ALT/AST > 100) / encephalopathy / maternal genital HSV — neonatal HSV until excluded (Kimberlin Pediatrics 2013 AAP Red Book 2024)
- [LIFE_THREATENING] Neonate 72 h - 28 d with sepsis features (new-onset apnoea, lethargy, poor feeding, hypotension, thrombocytopenia, line-associated source) — life-threatening late-onset sepsis per AAP late-onset clinical-report series

Citations

- AAP Clinical Report — Puopolo et al, Management of Neonates ≥35 wk With Suspected/Proven Early-Onset Sepsis, Pediatrics 2018 (PMID 30455342) + CDC Verani 2010 GBS prophylaxis (PMID 21088663) + Phoenix pediatric sepsis criteria JAMA 2024 (PMID 38245890) + FEAST fluid-bolus trial NEJM 2011 (PMID 21615299). Neonatal HSV (Kimberlin), candidiasis (IDSA), and AAP Red Book cited by name. [PMID:30455342](https://pubmed.ncbi.nlm.nih.gov/30455342/)
- Cited evidence (PMID 21088663) [PMID:21088663](https://pubmed.ncbi.nlm.nih.gov/21088663/)
- Cited evidence (PMID 24379228) [PMID:24379228](https://pubmed.ncbi.nlm.nih.gov/24379228/)
- Cited evidence (PMID 21873694) [PMID:21873694](https://pubmed.ncbi.nlm.nih.gov/21873694/)
- Cited evidence (PMID 38245901) [PMID:38245901](https://pubmed.ncbi.nlm.nih.gov/38245901/)

Last reconciled with current guidelines: 2026-05-22.
References
  • AAP Clinical Report — Puopolo et al, Management of Neonates ≥35 wk With Suspected/Proven Early-Onset Sepsis, Pediatrics 2018 (PMID 30455342) + CDC Verani 2010 GBS prophylaxis (PMID 21088663) + Phoenix pediatric sepsis criteria JAMA 2024 (PMID 38245890) + FEAST fluid-bolus trial NEJM 2011 (PMID 21615299). Neonatal HSV (Kimberlin), candidiasis (IDSA), and AAP Red Book cited by name. — PMID:30455342
  • Cited evidence (PMID 21088663) — PMID:21088663
  • Cited evidence (PMID 24379228) — PMID:24379228
  • Cited evidence (PMID 21873694) — PMID:21873694
  • Cited evidence (PMID 38245901) — PMID:38245901