Examination Physical assessment of the infant with nosocomial infection should include a systematic approach and should be repeated frequently. Serial examination provides greater understanding of the evolution of symptoms in the infant and provides a means for timely identification of changes that can then be properly addressed. Physical assessment is more valuable when performed with a complete knowledge of obstetric, peripartum, and neonatal history. A complete understanding of the current diagnosis, past procedures, and medication exposures can lead to a more focused and improved physical assessment. Physical assessment changes associated with sepsis can be subtle and nonspecific, and can also progress rapidly to shock and mortality within hours of the onset of infection Gestational age (Ballard score) , weight , length ,Smal or Large Gestational Age, maturity sign, conscious level(alert ,irritable , disturbed ).vital sign (temperature , heart rate , blood pressure , respiratory rate, sao2) , skin (pallor, jaundice , edema , ecchymosis , cyanosis ) , Abd exam ( distended abdomen, liver , spleen , kidney , umbilical cords abnormalities) chest exam ( apnea , tachypnea , stridor , grunting , Down score, retraction), cardiac exam ( bradycardia tachycardia , murmur , central cyanosis) , , skin pinch (delay or not) , anterior fontanel (depressed or not) , anthropometric measurements , neurological evaluation(reflexes) Monitoring of the ventilator settings