Chart — Neonatal
Early vs Late Neonatal Sepsis Chart
The timing tells the story. Early-onset comes from the mother; late-onset comes from the environment — and that single distinction drives the organisms, the risk factors, and the prevention.
Educational use only. Risk stratification and antibiotic choices follow neonatology guidance and facility protocol; organism patterns vary by setting. This material supports nursing education and exam review. It is not medical advice and is not a substitute for clinical judgment, institutional policy, or medical direction. Always follow facility protocols and current provider orders.
Side by Side
| Feature | Early-onset (<72 h) | Late-onset (>72 h) |
|---|---|---|
| Timing | Within ~72 hours of birth (often <24 h) | After ~72 hours (up to ~28–90 days) |
| Source | Vertical — from the mother before/during delivery | Horizontal — environment, caregivers, equipment, lines |
| Common organisms | Group B Strep (GBS), E. coli | Coagulase-negative staph, S. aureus, gram-negatives, Candida (NICU); UTI/meningitis in community |
| Risk factors | GBS colonization, chorioamnionitis/maternal fever, ROM ≥18 h, prematurity | Prematurity, central lines, ventilation, prolonged hospitalization, invasive procedures |
| Typical setting | Term and preterm; presents in the first days | Often NICU/hospitalized or post-discharge febrile infant |
| Prevention focus | Maternal GBS screening (36–37 wk) + intrapartum antibiotics | HAND HYGIENE, line-care bundles, fewer line days, breast milk |
Exam Traps
- ✦Early-onset = maternal/vertical: GBS and E. coli; the risk factors are obstetric (GBS, chorioamnionitis, ROM ≥18 h).
- ✦Late-onset = environment and lines — and hand hygiene is the #1 prevention.
- ✦Both present subtly — hypothermia, poor feeding, lethargy, apnea — not a dramatic fever.
- ✦Maternal GBS screening at 36–37 weeks + intrapartum penicillin is why early-onset GBS is now rarer.
- ✦Blood culture before antibiotics; empiric ampicillin + gentamicin.
Related Resources
Standards & sources
Fact-checked Jun 21, 2026This page is written to align with American Academy of Pediatrics (AAP) · Neonatal Resuscitation Program (NRP) · AWHONN. It is an educational summary, not a citation of any single document — always verify specific doses, values, and protocols against current guidelines and your facility policy. How we source content →