Early-onset neonatal sepsis — structured oral station (12 minutes)

Opening prompt — "Tell me what you do from the bedside."

Model response — say it in this order: ^[1][3]

• "This is suspected early-onset neonatal sepsis. The infant has the full risk tier — GBS-positive mother, prolonged rupture of membranes, intrapartum fever, and inadequate intrapartum prophylaxis, only 2 of the recommended minimum 4 hours. He is now showing systemic signs — grunting, tachypnoea, prolonged capillary refill, hypothermia. I would call the neonatal team immediately."
• "While they are coming, I would secure airway and breathing, give supplemental oxygen, obtain intravenous or intraosseous access, and assess for shock — a 10 mL per kilogram isotonic crystalloid bolus if perfusion does not improve."
• "I would take a blood culture before any antibiotic, send a full blood count and CRP, do a bedside glucose, and arrange a lumbar puncture once he is stable enough."
• "I would start empirical benzylpenicillin 60 mg per kilogram IV plus gentamicin 5 mg per kilogram IV within the hour, and state out loud that I will stop at 48 hours if the cultures are negative, the CRP is low and he is clinically well."^[1][3]

Examiner is listening for: parallel action, named drugs with doses, the culture-before-antibiotic sequence, and the explicit 48-hour checkpoint. ^[1]

Probe 1 — "Why benzylpenicillin and gentamicin, and not cefotaxime or ampicillin?"

• "Benzylpenicillin has reliable activity against GBS, which is the dominant term-infant pathogen, and gentamicin adds gram-negative cover and synergy. The combination is narrow, effective, and supports the stewardship principle of narrowing once an organism is identified."
• "NICE NG195 uses benzylpenicillin 25 mg per kilogram 12-hourly plus gentamicin 5 mg per kilogram every 36 hours; the AAP uses ampicillin plus gentamicin. Cefotaxime is reserved for specific settings such as suspected gram-negative meningitis. The agent differs by region; the principle — a beta-lactam plus an aminoglycoside — is the same."^[1][2]

Probe 2 — "How does the ANZ approach differ from the US Neonatal Sepsis Calculator?"

• "ANZ uses a risk-factor-based framework — GBS, intrapartum fever, ROM over 18 hours, prematurity — applied at the bedside. The US Neonatal Early-Onset Sepsis Calculator takes those factors plus gestational age and the infant's clinical appearance and returns a probability of EOS, on which the management recommendation hangs."
• "ANZ has not adopted the calculator universally, partly because it is calibrated to a US population with a different baseline GBS incidence. They are not interchangeable — name which you use and why."^[2][4]

Probe 3 — "The blood culture is negative at 48 hours. CRP is 8. He is feeding well. What now?"

• "Stop the antibiotics. The criteria for stopping — cultures negative, CRP low, infant clinically well and feeding — are all met."
• "Prolonged empirical broad-spectrum therapy in the preterm is associated with necrotising enterocolitis, late-onset sepsis and death; the 48-hour stop is the stewardship rule that protects against that harm. I would arrange discharge with a documented parental safety-net conversation."^[1][3]

Probe 4 — "The mother is upset and asks if the baby 'caught an infection from her'."

This is a scored communication domain, not a courtesy. Demonstrate it out loud: ^[1]

• Move to her eye level, use her name, and answer plainly: "Your baby became unwell in the first few hours, and we treated him with antibiotics because we were worried about an infection he may have picked up around the time of birth. The tests so far have not grown any bacteria. We are stopping the antibiotics now because he is well."^[1]
• Address the GBS colonisation directly and without blame: "About one in five women carry group B strep as part of their normal flora. It is not something you did wrong, and it is not a sexually transmitted infection. We screen for it because we know it can occasionally cause illness in newborns, and we treat to prevent that."
• Commit to a follow-up plan and a debrief.

Probe 5 — "What is your safety-net conversation at discharge?"

• "If he is not feeding well, is lethargic or floppy, feels hot or cold, or is breathing differently, bring him straight back. We would rather see him twice than miss something once."
• Document the conversation in the notes.^[1]