How is neonatal sepsis diagnosed?

Updated: Jun 13, 2019
  • Author: Nathan S Gollehon, MD, FAAP; Chief Editor: Muhammad Aslam, MD  more...
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Answer

Laboratory studies used to evaluate for early-onset and late-onset sepsis include a complete blood cell (CBC) count and differential, measurement of levels of C-reactive protein (CRP) and other infection markers. Culture of blood, urine, and cerebrospinal fluid (CSF) samples remains the gold standard. [37] A Gram stain may provide early identification of the gram-negative or gram-positive status of the organism for preliminary identification. DNA-based identification techniques are becoming available and may supplement culture results and provide rapid diagnostic information. [38] Rapid pathogen detection with multiplex polymerase chain reaction (PCR) may facilitate more timely selection of targeted antibiotic therapy while limiting exposure to broad-spectrum antibiotics. [39]

Because of the low incidence of meningitis in the newborn with negative blood culture results, clinicians may elect to culture the cerebrospinal fluid (CSF) of only those infants with documented or presumed sepsis. However, data from large studies show a 38% rate of culture-positive meningitis in neonates with negative blood culture results and suspected sepsis. Accordingly, a lumbar puncture should be considered when evaluating the infant with suspected sepsis.

Imaging studies employed in the workup of neonatal sepsis should target the neonate's symptoms and may include chest radiography to evaluate pulmonary involvement, as well as computed tomography (CT) scanning, magnetic resonance imaging (MRI), and ultrasonography of the head in cases of meningitis.


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