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Early-onset neonatal sepsis — RACP Paediatrics MCQ

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HardNeonatologyEarly-onset neonatal sepsisRACP Paediatrics

A term baby develops temperature instability and respiratory distress at 10 hours of age. The mother had intrapartum fever, prolonged rupture of membranes and received antibiotics shortly before birth. The baby has mottled skin and capillary refill of 4 seconds. What is the most appropriate management?

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Correct answer: B — Blood culture then empirical intravenous benzylpenicillin and gentamicin

This presentation is early-onset neonatal sepsis until proven otherwise, and blood culture should be obtained promptly followed by empirical intravenous antibiotics. Lumbar puncture may be needed but should not delay antibiotics in an unstable neonate. The key teaching point is that maternal fever plus poor perfusion in a newborn is a time-critical sepsis presentation.

Reference: Therapeutic Guidelines (eTG): Antibiotic; RCH Clinical Practice Guidelines: Sepsis assessment and management