1. Newborns At Risk for Sepsis Algorithm
Signs of Neonatal Sepsis
Yes
Full diagnostic evaluation with antibiotic therapy and NICU transfer No
Maternal Chorioamnionitis?
Yes
See Chorio Algorithm No
GBS Prophylaxis indicated for mother? No
Routine Newborn Clinical Care
Yes
Yes
See GBS Algorithm
Mother received ≥ 4 h of penicillin, ampicillin or cefazolin IV? No
Yes
See GBS Algorithm
≥ 35 wk AND duration of ROM < 18 h? No
Yes
See GBS Algorithm
< 35 wk OR duration of ROM ≥18 h?
Adapted from Reference: Algorithm for the Prevention of early-onset GBS infection in the newborn. Pediatrics, Vol 128, Number 3, Pg. 3, September 2011

2. Maternal GBS Colonization or GBS unknown status:
Care of the Well-Appearing Newborn at Risk for Sepsis
GBS colonization: GBS in urine this pregnancy, GBS disease in infant in prior pregnancy, GBS swab positive in last 5 weeks
GBS colonization, GBS unknown < 37 weeks 0 days, and GBS unknown ≥ 37 weeks 0 days with ROM ≥ 18 hours require IAP
Intrapartum Antibiotic Prophylaxis (IAP):
Adequate IAP = Mother received 1st dose Ampicillin or Cefazolin > 4 hrs prior to delivery
Inadequate IAP = Mother received 1st Ampicillin or Cefazolin < 4hrs prior to delivery (or not at all) or received Clindamycin or Vancomycin
Adequate IAP
Inadequate IAP
Without Risk Factors:
Infant > 35 weeks
AND
ROM < 18 hrs
Inadequate IAP
With Risk Factors:
Infant < 35 weeks OR
ROM > 18 hrs
· CBC with manual diff at 6 hrs of age
· Routine clinical care
If lab values are WNL, observe NB for 48 hrs
If lab values are abnormal, contact Newborn LIP and strongly consider Blood Culture, antibiotics and continuous monitoring
· Routine Newborn Care
· Observation for > 48 hrs*
*24 hrs may be adequate if other discharge criteria are met and there is ready access to medical follow up care
CPM: Newborns at Risk for Sepsis ;

3. CPM: Newborns at Risk for Sepsis ; 2/2016
Maternal Chorioamnionitis: Care of the Well-Appearing Newborn at Risk for Sepsis
Maternal fever ≥ 100.4°F without clear alternative explanation is adequate for a presumptive diagnosis of chorioamnionitis, even in the absence of other features: tachycardia > 100, leukocytosis, uterine tenderness, foul-smelling amniotic fluid or fetal tachycardia > 160.
Dedicated NRP team attends delivery if chorioamnionitis is diagnosed
Maternal Temp > 101 °F
Up to 1 hour post delivery
Maternal Temp °F
Up to 1 hour post delivery
NB High Risk for Sepsis
NB Moderate Risk:
PROM > 18 hrs OR < 37 weeks
NB Low Risk:
> 37 weeks AND ROM < 18 hrs.
Initial NB transition care (up to 2 hrs of age)
Followed by blood culture and initiation of antibiotic therapy
CBC with manual diff at 6-12 hrs of age
Close observation / monitoring for 12 – 24 hours
· CBC with manual diff & blood culture completed at 4-6 hrs of age
· Results called to Newborn provider
· Labs & History reviewed by Newborn provider
Evaluate potential for infant to be cared for within routine couplet care assignment after
12-24 hrs of age.
NB hospital stay ≥ 48 hrs
Abnormal Lab Results
Newborn provider to consider antibiotics
If antibiotics initiated, close observation / monitoring for 12 – 24 hours
NB hospital stay ≥ 48 hrs
Results WNL’s
Infant cared for within routine couplet care assignment.
Antibiotics not started.
Newborn provider may consider serial CBCs.
NB hospital stay ≥ 48 hrs
CPM: Newborns at Risk for Sepsis ; 2/2016