What are the key clinical signs of neonatal sepsis that I should be vigilant for in a newborn?

Key clinical signs of neonatal sepsis that healthcare professionals should be vigilant for include:

• Red flag signs: apnoea (temporary stopping of breathing), seizures, need for cardiopulmonary resuscitation, need for mechanical ventilation, and signs of shock ¹.
• Altered behaviour or responsiveness, such as appearing ill, not waking or not staying awake when roused, weak high-pitched or continuous cry ¹,².
• Altered muscle tone, for example, floppiness ¹.
• Feeding difficulties including feed refusal, feed intolerance, vomiting, excessive gastric aspirates, and abdominal distension ¹.
• Abnormal heart rate: bradycardia or tachycardia ¹.
• Signs of respiratory distress such as grunting, chest recession, tachypnoea, nasal flaring, and hypoxia (central cyanosis or reduced oxygen saturation) ¹,²,³.
• Temperature abnormalities: hypothermia (below 36°C) or fever (above 38°C) unexplained by environmental factors ¹,².
• Jaundice within 24 hours of birth ¹.
• Signs of neonatal encephalopathy and bulging fontanelle ¹,².
• Unexplained excessive bleeding, thrombocytopenia, or abnormal coagulation ¹.
• Altered glucose homeostasis (hypoglycaemia or hyperglycaemia) and metabolic acidosis ¹.
• Skin changes such as mottled or ashen appearance, cyanosis of skin, lips or tongue, and non-blanching rash ²,³.
• Other signs include persistent pulmonary hypertension of the newborn and seizures ¹,².

Healthcare professionals should consider these signs collectively, especially the presence of any red flags or multiple clinical indicators, to promptly identify and manage neonatal sepsis ¹,².