Recommendation ID
CG149/2
Question
Risk factors for early-onset neonatal infection and symptoms and signs:- Which risk factors for early-onset neonatal infection, clinical symptoms and signs of infection, and laboratory investigations should be used to identify babies who should receive antibiotics?
Any explanatory notes
(if applicable)
Why this is important:- The evidence reviewed for the guideline included several risk scoring models designed to identify babies at risk of developing an early-onset neonatal infection and in whom antibiotic treatment should be started. The models – which incorporated maternal and fetal risk factors for infection, clinical symptoms and signs of infection, and the results of laboratory investigations (such as Creactive protein concentrations) – were intended for use before or after birth of the baby.
However, the models were suboptimal because they were not specific to early-onset neonatal infection, or they were based on data collected using a case–control design (which tends to overestimate predictive accuracy because it includes extremes of the risk spectrum but not the harder to classify patients who are not obviously free from infection or confirmed as having an infection), or they did not examine predictive accuracy in independent training and validation sets. Further research is needed, particularly to examine risk scoring models that incorporate measurements from novel laboratory investigations, such as molecular diagnostics (polymerase chain reaction and 16S approaches). The ideal study design would be a randomised controlled
trial that compares clinical outcomes associated with particular investigation and treatment
initiation strategies. The next best design would be a prospective cohort study to determine the
predictive accuracy of an investigation strategy or a risk scoring model evaluated in a clinically
relevant group of babies that is independent of the study population used to derive the risk
scoring model.

Source guidance details

Comes from guidance
Neonatal infection (early onset): antibiotics for prevention and treatment
Number
CG149
Date issued
August 2012

Other details

Is this a recommendation for the use of a technology only in the context of research? No  
Is it a recommendation that suggests collection of data or the establishment of a register?   No  
Last Reviewed 03/09/2012