Brief comments on three existing approaches for managing neonates at risk of early-onset sepsis

Table 3 Minor and major clinical symptoms and criteria suggesting observation or laboratory evaluation and antibiotic treatment

Minor ‡	Major
Mild respiratory distress (> 60 bpm) without the need of respiratory support	Moderate to severe respiratory distress (requiring respiratory support) § → tachypnoea plus increased respiratory effort
Tachycardia > 160 bpm	Hypoxia, reduced SpO2 saturation
Metabolic acidosis (base excess ≤ − 10 mmol/lt)	Reduced skin perfusion, Refill time ≥ 3 “ Signs of shock
Temperature < 36° or > 37.5 < 38 °C	Temperature ≥ 38 °C
	Greyish, pallor or marbling of the skin colour
	Worsening of general wellbeing, apnoea, lethargy, irritability, convulsions

SpO2, Saturation of peripheral oxygen
‡ On the basis of the clinician’s judgment laboratory evaluation can be delayed in the presence of minor, initial, unspecific and non-progressive symptoms during the first 12–24 h of life. Neonates with mild symptoms are re-evaluated at 2-h intervals. The presence of major symptoms, the worsening or persistence (for 12–24 h) of minor symptoms suggest laboratory evaluation and (eventually) empirical antibiotics, but the decision is left to the clinician’s discretion
§ respiratory support includes mechanical ventilation and nasal continuous positive airway pressure. However, it does not necessarily include high flow nasal cannula

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