Sepsis in the newborn: urgency and uncertainty in neonatal sepsis

Abstract

Background: Neonatal sepsis is a syndrome characterized by systemic signs and symptoms of infection along with bacteremia in the first month of life. It remains a leading cause of neonatal morbidity and mortality worldwide, particularly in low- and middle-income countries. Early diagnosis is challenging because of non-specific clinical manifestations. Methods: A cross-sectional study was conducted from February 2026 to April 2026 at Rapti Academy of Health Sciences, Nepal. Medical records of 125 neonates aged 0-28 days who underwent sepsis screening were analyzed. Clinical, demographic, and laboratory parameters were evaluated to identify predictors of culture-confirmed neonatal sepsis. Results: Among 125 neonates, 62 (50%) had culture-confirmed sepsis. Gestational age below 30 weeks, CRP ≥12 mg/L, increased monocyte percentage, and low Apgar score (<7 at 5 minutes) were significant predictors of neonatal sepsis. Hypoglycemia, elevated micro-ESR, and abnormal gastric aspirate smear findings were commonly associated with sepsis. Conclusions: Neonatal sepsis remains a major cause of morbidity and mortality. Early recognition of clinical and laboratory predictors may facilitate prompt diagnosis and timely management, thereby improving neonatal outcomes.