The healthcare guidance body, NICE, has today (22 August) published new guidelines on the use of antibiotics for the prevention and treatment of early-onset (within 72 hours of birth) neonatal infection. The guidance recommends that the NHS needs to prioritise the treatment of sick babies and use antibiotics appropriately to avoid the development of bacterial resistance to antibiotics.

Early-onset neonatal bacterial infection is a major cause of mortality and morbidity in newborn babies. It is the cause of death for 1 in 4 babies who develop it, even when they are given antibiotics. These infections are usually caused by organisms from the mother's genital tract, including group B Streptococcus (GBS), E.coli, Pseudomonas and Klebsiella. Such infections may develop suddenly and rapidly, with mortality particularly high in premature babies and those with a low birth weightⁱ. They may also lead to the development of cortical lesionsⁱⁱ in the brain, and so subsequently cause neuro-developmental delay.

The new guideline makes a number of recommendations, including:

• A framework based on risk factors and clinical indicators should be used to identify and treat babies with an increased likelihood of having an early-onset neonatal infection.
• Intrapartum antibiotic prophylaxisⁱⁱⁱ should be offered in a timely manner to women whose babies are at higher risk of infection.
• Babies with suspected early-onset neonatal infection should receive antibiotics as quickly as possible (within 1 hour of the decision to treat).
• Benzylpenicillin and gentamicin should be used in combination as the first-choice antibiotic regimen for treating suspected early onset neonatal infection.
• When starting antibiotic treatment in babies with risk factors for infection or clinical indicators of possible infection, perform a blood culture before administering the first dose.

Professor Mark Baker, Director of the Centre for Clinical Practice at NICE said: “Early onset neonatal infection can be very serious and, at present, there is much variation in how it is managed, with sometimes unnecessary delays in recognising and treating sick babies. Many babies are receiving antibiotics needlessly, and consequently, there is concern that the effectiveness of antibiotics is being reduced because of the development of resistance to them. I am sure this new guideline will be welcomed as a useful tool for all those healthcare professionals working in this area.”

Mark Turner, Senior Lecturer and Consultant in Neonatology, University of Liverpool and Liverpool Women's NHS Foundation Trust and chair of the guideline development group said: “I was very pleased to be involved in the development of these important new guidelines which set out clear recommendations for those treating and managing neonatal infection. The NHS needs to prioritise treatment for sick babies as well as ensure antibiotics are used sensibly.”

Farrah Pradhan, parent member of the guideline development group said: “As a parent of two children that were both born prematurely, I know first-hand what a difficult and trying time this can be, especially if a baby also has a bacterial infection. I welcome these guidelines, and I hope they will help healthcare professionals deliver excellent care to pregnant women and their newborn babies.”

The new guideline is available from the NICE website at 00:05 hrs on Wednesday 22 August.

Ends

Notes to Editors

References and explanation of terms

i. Low birth weight is defined as between 1500 and 2499 grams.

ii. Cortical lesions are areas of injury or disease on the cortex (outer layer) area of the brain.

iii. Intrapartum antibiotic prophylaxis is defined asthe mother receiving intravenous benzylpenicillinat least four hours before delivery.

About the guideline

The new guideline is available from 00:05 hrs on Wednesday 22 August on the NICE website

Embargoed copies are available on request; please contact the press office.

Related NICE guidelines

• Caesarean section. NICE clinical guideline 132 (2011).
• Bacterial meningitis and meningococcal septicaemia. NICE clinical guideline 102 (2010).
• Induction of labour. NICE clinical guideline 70 (2008).
• Antenatal care. NICE clinical guideline 62 (2008).
• Intrapartum care. NICE clinical guideline 55 (2007). Update in progress. Publication date to be confirmed.
• Urinary tract infection in children. NICE clinical guideline 54 (2007).
• Feverish illness in children. NICE clinical guideline 47 (2007). Update in progress. Publication expected May 2013.
• Postnatal care. NICE clinical guideline 37 (2006).

About NICE

The National Institute for Health and Care Excellence (NICE) is the independent organisation responsible for providing national guidance and standards on the promotion of good health and the prevention and treatment of ill health

NICE produces guidance in three areas of health:

• public health - guidance on the promotion of good health and the prevention of ill health for those working in the NHS, local authorities and the wider public and voluntary sector
• health technologies - guidance on the use of new and existing medicines, treatments, medical technologies (including devices and diagnostics) and procedures within the NHS
• clinical practice - guidance on the appropriate treatment and care of people with specific diseases and conditions within the NHS.

NICE produces standards for patient care:

• quality standards - these reflect the very best in high quality patient care, to help healthcare practitioners and commissioners of care deliver excellent services
• Quality and Outcomes Framework - NICE develops the clinical and health improvement indicators in the QOF, the Department of Health scheme which rewards GPs for how well they care for patients

NICE provides advice and support on putting NICE guidance and standards into practice through its implementation programme, and it collates and accredits high quality health guidance, research and information to help health professionals deliver the best patient care through NHS Evidence.