Which signs in a neonate suggest sepsis requiring urgent evaluation?

• A. Temperature instability, lethargy, poor feeding, tachycardia or tachypnea, grunting, or poor perfusion
• B. Stable temperature, normal feeding
• C. Only respiratory distress with no fever
• D. Hyperactivity and excessive weight gain

Answer: (A)

In newborns, sepsis can present with subtle, non-specific changes, so any signs of systemic instability warrant urgent evaluation. Temperature instability matters because infection can cause either fever or dangerously low temperature in neonates. Lethargy and poor feeding reflect the infant’s energy depletion and CNS or overall illness, making them high-priority red flags. Tachycardia and tachypnea signal the body's stress response to infection and often accompany early sepsis or respiratory involvement. Grunting indicates respiratory distress, which together with infection can point to a sepsis-related pulmonary process. Poor perfusion suggests progression toward septic shock, with diminished blood flow to tissues.

Taken together, these signs—temperature instability, lethargy, poor feeding, rapid heart rate or rapid breathing, grunting, and poor perfusion—identify neonates who need urgent sepsis evaluation and treatment.

If a neonate has stable temperature and normal feeding, sepsis is less likely at that moment, though not impossible. Isolated respiratory distress without fever can occur but is less concerning than the constellation of systemic signs. Hyperactivity and excessive weight gain are not typical presentations of neonatal sepsis.