Neonatal bacterial infection and sepsis: SAQ

This infant presents at 18 hours of life with temperature instability, respiratory distress (grunting, retractions, tachypnoea), and neurological signs (lethargy, poor feeding). He was born at 36 weeks to a mother with chorioamnionitis and prolonged rupture of membranes, placing him at high risk for early-onset sepsis. ^[1]

Question 1 (10 marks)

Outline your initial assessment and investigation plan for this infant. ^[1]

Begin with an ABC assessment and overall gestalt of whether the infant appears sick or well. This infant is unwell: he has grunting respirations, tachypnoea, temperature instability, and lethargy. Obtain a full set of vital signs including heart rate, blood pressure, capillary refill, and oxygen saturation. Examine the anterior fontanelle, chest, abdomen, and skin for focal signs of infection. ^[1]

The investigation plan is a full septic workup. Obtain a blood culture with at least 1 mL before starting antibiotics. Send a complete blood count with differential and immature-to-total neutrophil ratio, and a baseline CRP. Perform a lumbar puncture for CSF analysis (cell count, protein, glucose, Gram stain, and culture) if the infant is stable enough. Send a chest X-ray for the respiratory distress. Check a bedside blood glucose immediately. Recheck the CRP at 24 hours. ^[2]