General physical examination changes in the infected infant will include decreases in tone and activity level. Trends toward fluctuation in temperature (hypothermia and hyperthermia. and vital signs (hypotension, tachycardia, and bradycardia) are often early signs of infection. Neurologic findings can include a bulging fontanel, jitteriness, or seizures. However, newborn seizures can be difficult to diagnose clinically. Electroencephalogram may be beneficial if seizures are suspected. Skin changes are typically secondary to decreased perfusion in shock, and can present as mottling, decreased capillary refill, and cyanosis. More focal lesions can be identified including pustules, vesicles, petechiae, erythema, and papules. Jaundice can also be associated with the infected newborn. Eye drainage, and injection of the sclera, is a focal finding associated with conjunctivitis. Nasal discharge and drainage from the otic canals are also associated with local infection.