Background. In adults severely disturbed microcirculatory flow can be observed by Orthogonal Polarized Spectral (OPS) imaging techniques during sepsis. Therefore we set out to assess for microcirculatory changes in term newborns with suspected early onset infection using OPS. Methods. OPS images were obtained prospectively from the vascular bed of the ear conch and upper arm of 47 newborns on their 1st, 2nd, and 3rd day of life. OPS sequences were analyzed semiquantitatively offline and blinded to clinical status of the infant. Flow in vessels was classified as continuous or noncontinuous flow and given as proportion of total vessels per image as in the studies in adults. Results. The proportion of vessels with continuous flow was significantly lower in the infants with infection (69% [56–81] versus 90% [87–94] ). None of the infants with infection was in shock or severely septic. Conclusion. In term neonates the microcirculatory flow is impaired in a large proportion of vessels even in mild to moderate infection. These changes can be observed at the onset of disease at the external ear, an optimal site for microcirculatory measurements in term infants. 1. Introduction Early onset neonatal sepsis within the first 72 hours of life [1] is a leading cause of postnatal mortality and morbidity and causes up to 1.6 million deaths worldwide each year. With early antibiotic treatment mortality and morbidity can be decreased significantly. Clinical signs of infection such as pallor or grey skin color, prolonged capillary filling time and temperature instability are caused by altered microcirculation. Inflammatory mediators released by macrophages lead to endothelial damage resulting in capillary leak, changes in coagulation with reduced deformability of red blood cells, and decrease in the number of perfused vessels [2–4]. All these changes result in an impaired microcirculation with disturbed flow, which is fundamental in the development of organ dysfunction in sepsis [5–10]. Noninvasive technology such orthogonal polarization spectral (OPS) imaging technique has made it possible to observe the microcirculation in vivo in humans [11]. This method provides high resolution images of the microvascular architecture to a depth of 1？mm. OPS has been validated by multiple studies in animals and human [11–14]. In adults the best accessible site is the vessels under the tongue. In infants and young children the buccal mucosa has also been used [15]. We have shown in the past that parameters of the microcirculation can be quantified in the skin under the axilla of
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