The nurse should recognize which of the following signs as a manifestation of sepsis in the neonate? Select all that apply.

Choice A rationale Poor tone, or lethargy and hypotonia, is a common and often subtle non-specific sign of systemic illness in neonates because the central nervous system is affected by circulating bacterial toxins or poor tissue perfusion. The newborn may appear listless, "floppy," or difficult to arouse, indicating a significant compromise in neurological and physiological status secondary to sepsis. Choice B rationale Tachypnea, a respiratory rate greater than 60 breaths per minute, is a compensatory mechanism to combat the metabolic acidosis that often occurs in sepsis, or it may be due to a primary respiratory infection. Increased respiratory effort is a critical sign of distress in the newborn, reflecting the body's attempt to improve oxygenation and remove excess carbon dioxide. Choice C rationale Hypothermia (a body temperature < 36.5&deg;C or 97.7&deg;F) is a highly specific and often more common indicator of severe infection and sepsis in the neonate than fever. The newborn's immature thermoregulatory center can fail to mount a febrile response, and metabolic demands during sepsis can overwhelm the ability to maintain core body temperature. Choice D rationale A sunken fontanel usually indicates dehydration, a condition that can accompany sepsis, particularly if the infant has poor feeding or is vomiting/diarrheal. However, the signs of sepsis itself are often related to systemic inflammatory response, with a bulging fontanel being a more common sign if the neonate develops meningitis, a complication of sepsis. Choice E rationale Hypoglycemia (blood glucose typically < 40 mg/dL) is a frequent manifestation of neonatal sepsis. The overwhelming infection stresses the newborn's system, leading to increased metabolic rate and glucose consumption, combined with poor intake and potential liver dysfunction, which results in depleted glycogen stores and subsequent low blood sugar levels.