Neonatal Sepsis: Updated Approaches

Abstract

Background: Neonatal sepsis remains one of the leading causes of neonatal morbidity and mortality worldwide, particularly in low- and middle-income countries. Despite advancements in neonatal intensive care, early diagnosis and effective management continue to pose significant clinical challenges due to nonspecific presentation, antimicrobial resistance, and limited availability of rapid diagnostic tools [1-3]. Objective: This review aims to comprehensively summarize the current understanding of neonatal sepsis including epidemiology, etiopathogenesis, risk factors, diagnostic modalities, antimicrobial management, emerging biomarkers, preventive strategies, and recent advances in neonatal sepsis care [4-6]. Methods: A narrative review of literature published between 2019 and 2022 was conducted using PubMed, MEDLINE, Scopus, Web of Science, Springer, and Elsevier databases. MeSH terms including neonatal sepsis, early-onset sepsis, late-onset sepsis, neonatal infection, sepsis biomarkers, antimicrobial resistance, and neonatal intensive care were utilized. Peer-reviewed articles, systematic reviews, meta-analyses, randomized controlled trials, and clinical practice guidelines were included [7-9]. Results: Neonatal sepsis is a multifactorial syndrome caused by bacterial, viral, and fungal pathogens. Earlyonset sepsis is commonly associated with maternal and perinatal factors, whereas late-onset sepsis is predominantly healthcare-associated. Blood culture remains the gold standard for diagnosis; however, biomarkers such as C-reactive protein, procalcitonin, interleukins, presepsin, and molecular diagnostic techniques are increasingly utilized for rapid detection. Timely antimicrobial therapy, supportive intensive care, infection prevention practices, antimicrobial stewardship, and evidence-based neonatal care protocols significantly improve outcomes [10-13]. Conclusion: Neonatal sepsis requires early recognition, rapid diagnosis, and multidisciplinary evidence-based management to reduce mortality and long-term complications. Advances in molecular diagnostics, biomarker research, antimicrobial stewardship, and preventive neonatal care strategies are expected to improve future outcomes significantly [14, 15].