Neonatal sepsis is a severe condition with high morbidity and mortality. Early diagnosis and appropriate use of antimicrobials are essential, but indiscriminate use is associated with dysbiosis and bacterial resistance. In this regard, antimicrobial stewardship programs are necessary to reduce excessive consumption and improve therapeutic efficacy. This review aims to assess antimicrobial consumption measures in neonates, focusing on the treatment of neonatal sepsis. The review was registered on Protocols.io and followed the PRISMA-ScR guidelines for systematic reviews. Original observational studies involving neonates, addressing sepsis or healthcare-associated infections, and presenting antimicrobial consumption metrics were included. Studies on reviews, prophylactic antimicrobial use, use for less than three days, pharmacokinetic or pharmacodynamic studies, and those with mixed populations without separate analysis of neonates were excluded. The search was conducted in Scopus, PubMed, LILACS, Cochrane, and BVS databases, using MeSH and Emtree descriptors. The final analysis included 14 studies, totaling 37,214 patients, and found that the main metrics used were Days of Therapy (DOT) and Defined Daily Dose (DDD). Although the results show variations in consumption practices, most studies emphasize reducing the use of broad-spectrum antimicrobials and the need for stewardship programs to rationalize use. Standardizing these metrics, through new studies and guidelines, is essential to improving neonatal care and preventing excessive antimicrobial use, thereby mitigating long-term adverse effects.