A neonate with fever and lethargy; what is the most appropriate initial action?

• A. Delay antibiotics pending additional tests.
• B. Initiate broad-spectrum antibiotics immediately without cultures.
• C. Wait for 24 hours before starting antibiotics.
• D. Obtain blood cultures and start empiric IV antibiotics after sepsis evaluation.

Answer: (D)

Fever and lethargy in a newborn is a red flag for possible sepsis, a situation in which rapid deterioration can occur because the infant’s immune system is immature. The priority is to diagnose and treat quickly. The best initial action is to perform a sepsis workup with blood cultures and promptly start empiric broad-spectrum IV antibiotics. This approach maximizes the chance of identifying the causative organism and begins therapy before results come back, which is crucial since delaying antibiotics increases mortality in neonatal sepsis. Cultures should be drawn as part of the workup, but therapy should not be postponed waiting for results; begin treatment now and refine once cultures are positive.