Neonatal sepsis remains a major cause of preventable morbidity and mortality, yet its diagnosis and management are complicated by diagnostic uncertainty, limitations in available tests, and inappropriate or delayed clinical decision-making. Diagnostic errors, suboptimal testing strategies, and inconsistent treatment approaches can contribute to poor outcomes in newborns.

Diagnostic stewardship offers a framework for improving the diagnostic pathway by ensuring that the right diagnostic test is used for the right patient at the right time and that results are appropriately interpreted and acted upon. In neonatal sepsis, this approach emphasizes careful assessment of clinical risk, appropriate selection and timing of diagnostic tests, avoidance of unnecessary testing, and integration of test results with clinical reasoning.

This article highlights the role of diagnostic stewardship and diagnostic reasoning in improving the management of neonatal sepsis. It discusses the importance of optimizing diagnostic pathways, strengthening clinical decision-making, and using tools such as computerized clinical decision support, direct feedback, and real-time evaluation to improve practice. Evidence suggests that effective diagnostic stewardship can improve diagnostic accuracy, reduce unnecessary healthcare expenditure, support appropriate antimicrobial use, and improve neonatal survival.

Although implementation challenges remain, integrating diagnostic stewardship and reasoning into neonatal care has considerable potential to improve outcomes. Successful implementation will require context-specific strategies, multidisciplinary collaboration, healthcare-worker engagement, and further implementation research. By promoting evidence-based diagnostic decisions and the appropriate use of diagnostic tests, healthcare systems can improve the quality of neonatal sepsis care and save newborn lives.

Daniel Geleta is affiliated with the Department of Epidemiology and Biostatistics at Jimma University, Jimma, Ethiopia. His academic and professional interests include neonatal and child health, infectious diseases, diagnostic approaches, and improving the quality and outcomes of healthcare. He has contributed to research and scholarly work focused on strengthening evidence-based clinical practice and improving health outcomes in resource-limited settings.