When should antibiotics NEVER be withheld in an ill neonate?

In the context of caring for ill neonates, the decision to administer antibiotics is critical, particularly when considering their vulnerability to infections. Administering antibiotics should never be withheld when the complete blood count (CBC) and C-reactive protein (CRP) are normal if there are clinical signs or a high suspicion of sepsis or other serious infections. This is because relying solely on lab results may not provide the full picture regarding the presence of an infection.

In neonates, infections can progress rapidly, and clinically, they may present with subtle signs that could easily be overlooked. Therefore, a neonate exhibiting symptoms of illness, regardless of CBC and CRP results appearing normal, should still be treated empirically with antibiotics to protect them from potential harmful outcomes associated with untreated infections.

Choosing not to treat based solely on normal lab results could lead to delay in appropriate therapy and potentially severe clinical consequences. This highlights the importance of clinical judgment along with laboratory findings in managing infections in this vulnerable population.