Low ANC (neutropenia) High immature to total WBC (>0.2) Thrombocytopenia CRP: elevated Blood sugar: hyperglycemia Hypoglycemia Coagulation studies: DIC WBC, white blood cells; DIC, disseminated intravascular coagulopathy; ANC, absolute neutrophil count Triage Considerations Any symptomatic neonate should be assessed for the possibility of neonatal sepsis Neonates should be triaged urgently due to the potential for rapid deterioration Shock and respiratory distress demand emergent treatment and initiation of resuscitation Rapid establishment of intravenous access and urgent antibiotic therapy are needed Meningitis can present in a similar fashion and could be part of the systemic infection Clinical Assessment History of GBS colonization in the mother, chorioamnionitis, prolonged rupture of membranes, maternal postpartum antibiotic use, or presence of maternal symptoms of infection (fever, rash, or URI) may raise clinicians’ suspicion of early infection Presence of sick contacts, CHD, and prematurity are risk factors that may be elicited in late-onset disease Physical examination may be notable for hypothermia or fever and may reveal a localized source of infection (e.g., pneumonia, meningitis, septic arthritis, herpetic rash, NEC, or omphalitis) However, examination findings are usually nonspecific ( Table 96.7 ) Neonates with signs of shock should be presumed to have neonatal sepsis but should also be evaluated for coarctation of the aorta and cardiogenic shock Clinicians can attempt to narrow diagnosis by history and physical examination to a specific cause, however, this can be very difficult Complete blood count with differential will reveal leukocytosis or leukopenia, and may also show neutropenia, elevated immature to total white blood cell (WBC) ratio above 0.20 (calculated as immature cells [bands + myelocytes + metamyelocytes] divided by total neutrophils) C-reactive protein (CRP) is an acute phase reactant that becomes elevated to hours after infection It reaches peak around 24 hours after initiation of infection and can be used to monitor response to treatment, and optimize duration of treatment Other acute phase reactants and cytokines are being studied as markers of disease including procalcitonin and interleukin (IL)-6, IL-8, tumor necrosis factor-alpha, and