General approach to managing hospital-acquired sepsis or septic shock of unknown source in neonates and children younger than 2 months
Seek expert advice for the management of neonates with confirmed sepsis or microbiologically proven infection.
For advice on recognising sepsis and septic shock, see Identifying sepsis or septic shock.
Follow local sepsis and septic shock protocols, if available. In the absence of local protocols, the empirical regimens in this topic may be appropriate. These empirical regimens are intended for initial therapy only (up to 48 hours). Modify therapy as soon as additional information is available (eg source of infection, results of Gram stain, culture and susceptibility testing).
Neonates may be at risk of resistant pathogens if their birthing parent (eg mother) had risk factors for infection with multidrug-resistant gram-negative bacteria or methicillin-resistant Staphylococcus aureus (MRSA).
Evaluate the appropriateness of antimicrobial therapy daily, with consideration given to the neonate or child’s clinical status and the principles of antimicrobial stewardshipBurston 2017.
The recommendations in this topic apply to:
- term neonates (gestational age 37 weeks or older) and preterm neonates (gestational age younger than 37 weeks) with late onset sepsis or septic shock (occurring after 72 hours of birth) who have been in hospital since birth
- children younger than 2 months who have hospital-acquired sepsis or septic shock.
Antimicrobial choice depends on whether meningitis has been excluded (usually by lumbar puncture). For empirical regimens, see:
- Hospital-acquired sepsis or septic shock in neonates and children younger than 2 months who do not have meningitis
- Hospital-acquired sepsis or septic shock in neonates and children younger than 2 months who may have meningitis.
Add-on therapy is required if HSV infection is suspected or if the neonate or child younger than 2 months is at increased risk of MRSA infection (eg exposed to a caregiver colonised with MRSA).
The empirical regimens in this topic may also need to be modified according to local epidemiology, if known.