The role of physical examination in the identification of neonates with early-onset sepsis

Abstract

Early-onset sepsis (EOS), defined as infection within the first 72 h of life, remains a major concern in neonatal care. Historically, many late preterm (≥34 weeks) and term infants at risk for infection (e.g., exposure to maternal intraamniotic infection [chorioamnionitis], or prolonged rupture of membranes) received empiric antibiotics after birth. However, most of these infants were ultimately without infection, leading to unnecessary antibiotic exposure, NICU admissions, and disruptions in maternal-infant bonding. Recent evidence and guidelines support serial physical examinations (SPEs) or structured clinical observation as a safe and effective alternative to routine empiric antibiotics in well-appearing infants. The purpose of this review is to describe the evidence supporting SPEs as a safe and effective strategy for managing well-appearing late preterm and term infants at risk for early onset sepsis.