A term infant 48 hours of age suddenly develops hypoxemia, irritability, and glucose and temperature instability. Which of the following statements are true?

a. Empiric antibiotic coverage for b-hemolytic Streptococci and Escherichia coli should be initiated

d. The mortality rate for this child is approximately 50%

This infant has the classical findings of neonatal sepsis. This is defined as a generalized bacterial infection accompanied by a positive blood culture during the first month of life. Early onset sepsis occurs during the first week of life, and is due primarily to maternal organisms, such as b-hemolytic Streptococci, Escherichia coli or Listeria monocytogenes. The mortality rate of early onset sepsis is approximately 50 percent. Late onset sepsis is due primarily to hospital acquired organisms such as Staphylococcus epidermidis, Staphylococcus aureus or Pseudomonas species, and the mortality rate for this entity is approximately 20 percent.

The signs and symptoms of neonatal sepsis are subtle and nonspecific. Early signs include lethargy, irritability, temperature instability, change in the respiratory pattern, or changes in the feeding pattern. Hematologic findings include thrombocytopenia, leukocytosis, or leukopenia. Hemodynamic manifestations occur late. Presumptive therapy should be based upon the suspected organism, but often includes Ampicillin or an anti-Staphylococcal agent plus an amino glycoside. A prostaglandin E1 infusion is inappropriate as this relates to patients with ductal-dependent congenital heart disease. Exogenous surfactant is unlikely to be helpful in a full-term infant who has previously been well and can be expected to begin his illness with a normal complement of pulmonary surfactant.