Serial clinical observation in early neonatal sepsis: insights from a national portuguese survey

Introduction and Objective:Early-onset neonatal sepsis (EOS) is a significant cause of neonatal morbidity and mortality.However, its incidence has declined in high-income countries due to improvements in maternal care and intrapartum antibiotic prophylaxis (IAP).This study aims to assess current practices in the management of asymptomatic, at-risk newborns in Portugal, three years after publication of the 2022 Portuguese Neonatal Society (SPN) consensus on EOS.Methods: An anonymous electronic questionnaire was distributed to 51 Portuguese neonatal units in 2025.Data regarding local protocols, adherence to the SPN consensus, assessment strategies, empirical antibiotic use, and implementation challenges were analyzed.The results were then compared to those of a national survey conducted in 2021 using the same methodology.Results: 45 neonatal units (88% of all units) responded in 2025.Most (75.6%) reported implementing the 2022 SPN consensus.The use of less invasive strategies, such as serial clinical observation in asymptomatic neonates with EOS risk factors, increased from 8.8% (3/34) in 2021 to 31.1% (14/45) in 2025.However, categorical risk-factor approaches remain prevalent.Barriers to adopting serial observation included concerns about workload, lack of confidence in clinical surveillance, and resistance to change.Conclusions: Portuguese units are increasingly aligning with national EOS guidance.Although the use of serial clinical observation has increased since 2021, it has not been widely adopted.Ongoing efforts are needed to address implementation barriers, such as resource allocation and training, to further reduce unnecessary antibiotic exposure in newborns at risk of EOS.