Neonatal sepsis: risk factors, early signs and nursing care

What it is

Neonatal sepsis is a bloodstream infection in the first weeks of life. Early-onset sepsis is usually passed from the mother around birth; late-onset sepsis comes later, often from the hospital or home environment. Its signs are vague and shared with many other newborn problems, so the nurse's frequent observation is what catches it. Nursing care includes reviewing the maternal risk factors, observing well babies at risk, strict hand hygiene and asepsis, reporting signs early, taking cultures cleanly and giving the prescribed antibiotics on time. Breast milk protects the baby.

Reference values

• Early-onset: in the Colombian guideline, within the first 3 days, most often in the first 24 hours; other sources use the first week.
• Normal temperature: 36.5 to 37.5 °C.
• Colombian guideline: the blood count is more useful taken at least 4 hours after birth; C-reactive protein helps decide how long to treat, not to diagnose.
• If cultures are negative and the baby improves, antibiotics are usually stopped at 48 to 72 hours.

What you need

• The maternal history: group B streptococcus result, rupture of membranes, fever, chorioamnionitis, intrapartum antibiotics.
• A thermometer, a pulse oximeter and a glucose meter.
• Hand hygiene supplies and sterile material for blood cultures and lines.
• The observation chart.

How to measure it (and why)

1. Review the maternal risk factors at birth and tell the doctor — they decide whether the baby is observed, tested or treated.
2. For a well baby at risk, keep the observation plan set by the doctor, next to the mother when possible — many need watching, not antibiotics.
3. Clean your hands before and after every contact and limit invasive procedures — prevents infection acquired in hospital.
4. Check temperature, heart and breathing rate, saturation, colour, perfusion and tone at each round — sepsis changes them early.
5. Watch feeding: weak suck, vomiting, a swollen abdomen — feeding changes are often the first sign.
6. Report the signs as soon as they appear, especially if there are several — the guideline acts on 3 or more signs.
7. Take the blood culture as ordered with strict aseptic technique — a contaminated sample gives a false result.
8. Give the prescribed antibiotics on time, per protocol, and watch the IV site — delays worsen the outcome.
9. Keep breastfeeding or expressed breast milk going when possible — breast milk protects against infection.

How to read it

• No single sign confirms sepsis; the combination and the change over time matter.
• Low temperature can be a sign of infection just like fever.
• A baby who looks worse than before needs treatment without waiting for results.
• Lumbar puncture is done when there are signs of infection or a positive blood culture; it can wait until the baby is stable, but antibiotics do not wait.

Next step: when to call for help

• Call at once for any sign of sepsis in a baby at risk, or for two or more signs in any baby.
• Call at once if the baby looks worse, is very sleepy, has apnoea or a seizure.
• At discharge, teach the family to go to the emergency department for any of the signs.
• Tell the doctor about a positive culture straight away.

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Elsewhere in DurgiPedia

• Neonatal immunity: maternal IgG and breast-milk IgA

Connections

← All of nursing

Educational content for students; it does not replace your institution's protocols, supervised clinical training or a prescriber's order. Dose-calculation examples use made-up numbers: they are educational, not a clinical order.

Sources: Guía de práctica clínica: recién nacido con sepsis neonatal temprana, para padres y cuidadores (Guía No. 06) (Ministerio de Salud y Protección Social de Colombia, Colciencias, 2013); Neonatal sepsis (MedlinePlus, U.S. National Library of Medicine, 2025); Salud sexual y reproductiva: guías para el continuo de atención de la mujer y el recién nacido focalizadas en APS, 3.ª ed. (CLAP/SMR 1577) (Organización Panamericana de la Salud, CLAP/SMR, 2011).

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