The issue of prophylactic and empiric antibiotics for preventing sepsis in the preterm neonate is neither new nor rare. Yet it remains important due to the controversies associated with it and the important implications it has for the health and survival of the preterm neonate.¹ Preterm delivery is an independent risk factor for sepsis and as the death rate from respiratory causes has declined, sepsis has become the leading cause of mortality in these vulnerable neonates.^2,3,4 The majority of preterm neonates have additional risk factors for sepsis such as maternal chorioamnionitis and prolonged rupture of membranes. Immature host defence mechanisms and inevitable exposure to invasive procedures and devices which put them at risk of overwhelming infections.^2,4-7
If antibiotic treatment is delayed for a preterm neonate who needs it, the consequences are devastating. Yet its  inadvertent use leads not only to prolonged hospital stay and increased cost of treatment and investigations but also to a number of adverse outcomes for the baby such as increased mortality, necrotizing enterocolitis (NEC), late-onset sepsis, fungal infections  and the emergence of resistant strains of microorganisms.^1,5,6; Therefore, all those involved with the care of the preterm neonate should strive to identify, as accurately as possible, the preterm neonate in need of antibiotics, and give the appropriate treatment judiciously, with safe and timely discontinuation.¹ The words “appropriate” and “judiciously”, however, impose huge challenges when translated into practical terms as every decision about the prevention, investigation and treatment of sepsis in the preterm neonate is attended by uncertainties and risks.^4,6 The methods and guidelines available leave a number of questions unanswered and there is a pressing need for cost-effective and dependable methods that will give quick results and guide practitioners to the right decisions in good time. ^6-8......