Differentiate early-onset and late-onset neonatal sepsis, and name one preventive strategy.

• A. Late-onset sepsis within 24 hours; organisms E. coli; Preventive strategy: intrapartum antibiotic prophylaxis.
• B. Early-onset sepsis after 7 days; organisms Staph aureus; Prevent: vaccine at birth.
• C. Early-onset sepsis after 2 days; organisms CoNS; Prevent: no hand hygiene.
• D. Early-onset sepsis within the first 72 hours (GBS, E. coli, Listeria); late-onset after 72 hours (CoNS, GBS, Gram-negative rods). Preventive strategy: intrapartum antibiotic prophylaxis for GBS-positive or unknown status and strict hand hygiene.

Answer: (D)

Early-onset neonatal sepsis is defined by onset within the first 72 hours after birth and is typically acquired from the maternal birth canal during labor. The usual culprits are group B Streptococcus, Escherichia coli, and Listeria monocytogenes. Late-onset sepsis occurs after 72 hours and is often acquired from the postnatal environment, including the NICU, with organisms such as coagulase-negative staphylococci, other Staphylococcus species, group B Streptococcus, and various Gram-negative rods.

Prevention centers on stopping maternal-to-neonatal transmission and preventing hospital-acquired infection. Screen pregnant patients for GBS and administer intrapartum antibiotic prophylaxis to those who are GBS-positive or have unknown status but are in labor or have ruptured membranes. In addition, strict hand hygiene and aseptic technique during delivery and in NICU care are crucial to prevent late-onset sepsis.