Serial physical examination for screening and management of early-onset neonatal sepsis: a pragmatic next step in the journey of antibiotic stewardship?

Early-onset neonatal sepsis (EOS) is a rare but serious illness in term or late preterm infants (incidence of 0.5–1/1000 live births) with a mortality rate of 2–3%. 1 Historically, the imperative to protect the few infants with genuine sepsis had led to a widespread use of antibiotics in many healthy newborns. However, growing concerns about antimicrobial resistance, disruption of the neonatal microbiome with possible implications for further late-onset diseases and unnecessary medicalisation in the postnatal period have prompted a reassessment of this approach. In the pursuit of both optimal neonatal EOS management and responsible antibiotic stewardship, clinicians have adopted structured risk management tools. Three principal approaches have emerged: categorical univariate risk assessment guidelines from the UK National Institute for Health and Care Excellence (NICE) and US Centers for Disease Control and Prevention (CDC); the Kaiser Permanente Sepsis Risk Calculator (SRC); and the serial physical examination (SPE) model. Each strategy offers distinct advantages and challenges, impacting antibiotic exposure, clinical outcomes and resource allocation.