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Intravenous ampicillin and an aminoglycoside are recommended for early-onset
sepsis. For full-term infants less than 7 days of age, 200 to 300 mg/kg/day of
ampicillin, intravenously, in three divided doses is the recommended dose; for
newborns beyond 7 days of age, 300 mg/kg/day, intravenously, in four divided
doses is recommended. Cefotaxime can be added for better CNS penetration if
gram-negative meningitis is suspected or if renal dysfunction precludes the use of
an aminoglycoside. Ceftriaxone should be avoided in neonates due to possibility
of exacerbating hyperbilirubinemia as a result of bilirubin displacement from
albumin, and the possibility of precipitating sludging in the gall bladder.
Intravenous vancomycin should be considered in neonates who have been at
home and exposed to community-acquired Staphylococci. Intravenous
vancomycin and an aminoglycoside are recommended for empiric therapy of lateonset sepsis until isolation of the specific pathogen occurs; at which time
antibiotic therapy can be tailored accordingly. Acyclovir should be considered if
there is suspicion for herpes simplex infection (suspicious vesicular rash,
transaminitis, or history of exposure). Doses and intervals of antibiotics and
antivirals can vary according to postgestational age, renal function, and liver
function. For an expanded discussion on fever in children 1 to 3 months of age,
please refer to Chapter 31 Fever .

Pneumonia in the Newborn
Neonatal pneumonia, similar to neonatal sepsis, can occur early (within the first
72 hours of life) or late (after 1 week of life). Early-onset pneumonia occurs as a
result of vertical transmission during the perinatal period, possibly through
aspiration of infected amniotic fluid or chorioamnionitis. Although Group B
streptococcal infection is the most common pathogen, other organisms similar to
those causing early sepsis can be responsible for infection (bacteria, viruses, and
fungi). Chlamydia trachomatis is also acquired perinatally. The long incubation
period in neonates causes infants to present around 2 to 4 weeks of age with an
insidious onset of a staccato cough without fever or wheezing. Infants who pass
through a vaginal canal infected with C. trachomatis have a 3% to 16% risk of
developing pneumonia. Tuberculosis and syphilis can also cross the placenta to

infect the fetus.
Late-onset pneumonia occurs as a result of horizontal transmission from the
infant’s surrounding environment; Streptococcus pneumoniae is the most
common organism. Other etiologic agents that cause late-onset sepsis are also
implicated in development of pneumonia. Acute respiratory failure and rapidly
evolving pneumonia can occur as a result of Bordetella pertussis infection in