Neonatal Sepsis: Diagnostic Challenges, Empirical Antibiotic Choices, And Stewardship

Abstract

Neonatal sepsis remains a formidable challenge in pediatric medicine, contributing significantly to neonatal morbidity and mortality worldwide. This narrative review synthesizes current knowledge regarding the diagnostic complexities, empirical antibiotic strategies, and the critical role of antimicrobial stewardship in managing neonatal sepsis. Early-onset sepsis (EOS) and late-onset sepsis (LOS) present distinct epidemiological profiles, pathogen distributions, and clinical manifestations, necessitating tailored diagnostic and therapeutic approaches. The non-specific nature of clinical signs in neonates, coupled with limitations of conventional diagnostic tools, often leads to diagnostic delays or overuse of broad-spectrum antibiotics. This review explores advanced diagnostic modalities, including novel biomarkers and risk assessment tools like the Neonatal Early-Onset Sepsis Calculator, which aim to refine diagnostic accuracy and reduce unnecessary antibiotic exposure. Furthermore, it critically examines current empirical antibiotic regimens, emphasizing the need for local epidemiological data and resistance patterns to guide appropriate choices. The imperative for robust antimicrobial stewardship programs (ASPs) in neonatal intensive care units (NICUs) is highlighted, focusing on strategies to optimize antibiotic use, mitigate antimicrobial resistance, and improve long-term neurodevelopmental outcomes. We discuss emerging pathogens, challenges in low- and middle-income countries (LMICs), and areas requiring further research to enhance the care of this vulnerable population.