Neonatal bacterial infection and sepsis: Viva

Branch 1: Risk assessment

The candidate should identify that this infant has multiple risk factors for early-onset sepsis: maternal GBS colonisation, inadequate intrapartum antibiotic prophylaxis (defined as less than 4 hours of antibiotics before delivery), and the presenting signs of temperature instability and poor feeding. This constellation warrants immediate evaluation. ^[1]

The Neonatal Early-Onset Sepsis Calculator is a validated tool for infants born at 34 weeks gestation or more that integrates maternal risk factors (GBS status, duration of membrane rupture, intrapartum fever, adequacy of intrapartum prophylaxis) with the infant's clinical presentation to estimate the probability of early-onset sepsis. The updated 2024 version uses a contemporary cohort reflecting current epidemiology. ^[3]

However, this infant is already symptomatic, so the clinical assessment overrides the calculator. Symptomatic infants need full evaluation and empiric antibiotics regardless of the calculated probability. The calculator guides decisions for asymptomatic or equivocally symptomatic infants. ^[1]