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Neonatal sepsis is notoriously difficult to detect because it is characterized by nonspecific signs that may overlap with normal infant behaviors. To determine which clinical signs are most strongly associated with neonatal sepsis and death, researchers conducted a large systematic review with meta-analysis. It included 52 studies involving 141,000 neonates <60 days of age across 30 countries; most studies were of good quality.
Of the 24 signs evaluated, poor feeding, prolonged capillary refill, and decreased consciousness were the ones most strongly associated with culture-confirmed sepsis. These same signs — along with an abnormal or absent cry — were also the ones most strongly associated with mortality.
The signs most st…