Clinical diagnosis of sepsis

Sepsis is one of the most important causes of neonatal morbidity and mortality especially in developing countries. As such, it is imperative that the doctor make an early diagnosis of possible infection in a newborn baby leading to early initiation of appropriate therapy. In a low resource setting this would possibly mean a clinical diagnosis. Sepsis unfortunately has a spectrum of symptoms involving almost all systems in the body. This includes features pertaining to the respiratory, cardiovascular and central nervous systems as also hematological and metabolic symptoms. Respiratory distress is one of the most commonly recognized presenting features of sepsis. In order to improve the clinical diagnosis of infections, various authors have constructed prediction models using different sets of clinical features. This might improve the sensitivity in diagnosing sepsis. Other interesting aspects in the diagnosis of sepsis are newer tests like heart rate analysis on ECG or colorimetric analysis of skin colour. Though still in the experimental phase, they seem to show promise in detecting sepsis before the clinical manifestations appear. This chapter gives an overview of the various manifestations of newborn systemic infections as also some recent advances in diagnosis.