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This study evaluated patterns of neonatal early onset sepsis (EOS) disease burden to guide approaches to EOS management. Retrospective cohort. A total of 1535 EOS cases were identified amongst 2,872,964 neonates born between 2010 and 2017 at 136 NICUs within the California Perinatal Quality Care Collaborative. EOS incidence was 7.4 per 1000 (E coli 4.3, GBS 1.1) in preterm, 0.76 per 1000 (E coli 0.29, GBS 0.22) in late preterm, and 0.31 per 1000 (E coli 0.07, GBS 0.13) in term neonates. There was no significant change in overall incidenc