In neonates, which statement is true regarding suspected sepsis?

• A. Only if blood culture positive
• B. Always septic until proven otherwise
• C. Only in preterm infants
• D. Blood culture positivity confirms sepsis

Answer: (B)

Neonatal sepsis is a clinical emergency where early treatment matters more than waiting for test results. The best approach is to treat a neonate with suspected sepsis as septic until proven otherwise. This reflects how quickly illness can progress in newborns and how cultures can be negative or delayed for various reasons (small blood volume, prior antibiotics, or low bacterial load). Starting broad-spectrum antibiotics and supportive care promptly improves outcomes while diagnostic testing is ongoing, even if cultures are not yet positive.

Relying on a positive blood culture to define sepsis isn’t reliable in this population, because a culture can be negative even when sepsis is present. Sepsis is about a systemic response to infection, not merely the presence of bacteria in the blood, and it can occur in term or preterm infants alike.