N EONNS X SPARTACUS PROBLEM

EOS — 

early-onset sepsis

In the 1960 film Spartacus, the Roman army succeeds in trapping the rebellious slave army led by the eponymous hero.1 The Romans know that Spartacus is a dangerous foe who must not escape; unfortunately, they have no idea what he looks like. To ensure that Spartacus is eliminated, the Romans elect to execute everyone. It is easy to see the parallels between Spartacus and our current approaches to sepsis in the newborn. Nursery clinicians are well aware that neonatal sepsis is dangerous and must not be missed, but the challenge of identifying the septic needle from the uninfected haystack of neonates is challenging. The most common approach is to adopt a “when in doubt, test and treat” tactic. As a result, clinicians (me included) are both inefficient and subjective in our diagnostic approach to sepsis. In this issue of Pediatrics, Schulman et al2 highlight this inefficiency in their study of antimicrobial use in >326 000 infants in 116 California NICUs.