Table 1.

Symptoms and classification of infant's clinical presentation according to serial clinical observation and neonatal sepsis calculator.

(A) Minor and major clinical symptoms and criteria suggesting observation or laboratory evaluation and antibiotic treatment [modified from Berardi et al. (14)].
Minor *	Major
Mild respiratory distress (> 60/m) without the need of respiratory support	Moderate to severe respiratory distress (requiring respiratory support)§ → tachypnoea plus increased respiratory effort
Tachycardia > 160 bpm	Hypoxia, reduced SpO2 saturation
Metabolic acidosis (base excess ≤ −10 mmol/l)	Reduced skin perfusion, Refill time ≥ 3 seconds, Signs of shock
Temperature <36° or > 37.5 <38 °C	Temperature ≥ 38 °C
	Grayish, pallor or marbling of the skin color
	Worsening of general wellbeing, apnoea, lethargy, irritability, convulsions
(B) Classification of infant's clinical presentation according to NSC (available at https://neonatalsepsiscalculator.kaiserpermanente.org).
Clinical exam	Description
Clinical illness	1. Persistent need for NCPAP / HFNC / mechanical ventilation (outside of the delivery room)
	2. Hemodynamic instability requiring vasoactive drugs
	3. Neonatal encephalopathy /Perinatal depression: - Seizure - Apgar Score at 5 min <5
	4. Need for supplemental O2 > 2 h to maintain oxygen saturations > 90% (outside of the delivery room)
Equivocal	1. Persistent physiologic abnormality > 4 h - Tachycardia (HR > 160) - Tachypnea (RR > 60) - Temperature instability (> 100.4°F or <97.5 °F) - Respiratory distress (grunting, flaring, or retracting) not requiring supplemental O2
	2. Two or more physiologic abnormalities lasting for > 2 h Tachycardia (HR > 160) - Tachypnea (RR > 60) - Temperature instability (> 100.4°F or <97.5 °F) - Respiratory distress (grunting, flaring, or retracting) not requiring supplemental O2
	Note: abnormality can be intermittent
Well appearing	No persistent physiologic abnormalities

SpO₂, Saturation of peripheral oxygen.

^*On the basis of the clinician's judgment, laboratory evaluation can be delayed in the presence of minor, initial, unspecific and non-progressive symptoms during the first 12–24 h of life. Neonates with mild symptoms are re-evaluated at 2-h intervals. The presence of major symptoms and the worsening or persistence (for 12¬24 h) of minor symptoms warrant laboratory evaluation and (eventually) empirical antibiotics, but the decision is left to the clinician's discretion.

^§Respiratory support includes mechanical ventilation. However, it does not necessarily include high flow nasal cannula or nasal continuous positive airway pressure.

HFNC, High Flow Nasal Cannula; HR, Heart Rate; NCPAP, Nasal Continuous Positive Airway Pressure; RR, Respiratory Rate.