Objective: To investigate secretory phospholipase A 2 (sPLA 2 ) activity in neonatal sepsis.Study Design: Plasma sPLA 2 activity, C-reactive protein (CRP) concentration, leukocyte count and immature/total neutrophil (I/T) ratio were assessed in a group of 156 infants admitted for neonatal intensive care, who were classified as documented sepsis (n ¼ 24), suspected infection (n ¼ 77) and controls (n ¼ 55). Interleukin-6 (IL-6) concentrations were assessed in a subgroup (n ¼ 29).Result: sPLA 2 activity, CRP concentration and I/T ratio were higher in sepsis than in suspected infection or control groups. sPLA 2 activity advanced with increasing CRP, I/T ratio and IL-6 was highest in infants with respiratory distress syndrome (RDS). Compared to CRP, sPLA 2 had equal sensitivity and lower specificity. Compared to I/T ratio, sensitivity and specificity of sPLA 2 were higher.Conclusion: Plasma sPLA 2 activity is increased in neonatal sepsis and highest in infants with RDS. Further studies should assess the potential of sPLA 2 inhibition in neonatal sepsis.