Neonatal infection: antibiotics for prevention and treatment

If clinical concerns about possible neonatal infection arise at any point:

• talk to the baby's parents and carers, explaining the reason for concern, and explain what neonatal infection is

• discuss the options for management that may be best for their baby (for example, observation, investigations or antibiotic treatment)

• do not delay treatment, but, when possible, give the baby's parents and carers time to think about the information they have been given and ask any questions they may have before making treatment decisions. [2021]

If giving antibiotics because of clinical concerns about possible early-onset neonatal infection or late-onset neonatal infection, discuss with parents and carers:

• the reason for the treatment

• the risks and benefits in relation to their baby's circumstances

• the observations and investigations that might be needed to guide treatment (for example, to help decide when to stop treatment)

• the preferred antibiotic regimen (including how it will be delivered) and likely duration of treatment

• the impact, if any, on where the woman, trans man or non-binary person or their baby will be cared for. [2021]

To maintain communication with a woman, trans man or non-binary person in labour whose baby is at increased risk of early-onset neonatal infection:

• involve the woman, trans man or non-binary person in any handover of care, either when additional expertise is brought in because of the risk of infection or during planned changes in staff

• include an update in the handover about the presence of any infection.
  
  For more guidance, see the section on communication in NICE's guideline on intrapartum care. [2012]

For babies who are considered to be at increased risk of early-onset infection, inform their parents and GP about this verbally and in writing:

• when the baby is discharged from the hospital or midwifery-led unit or

• in the immediate postnatal period, if the baby was born at home. [2012]

Reassure parents and carers that babies who have or are at increased risk of neonatal infection can usually continue to breastfeed, and that every effort will be made to help with this. If a baby is temporarily unable to breastfeed, provide support with expressing breast milk if needed. [2012]

When a woman, trans man or non-binary person is identified as having group B streptococcal colonisation, bacteriuria or infection during their current pregnancy:

• advise them that if they become pregnant again:

  • that their new baby will be at increased risk of early-onset group B streptococcal infection

  • they should inform their maternity care team that they have had a positive group B streptococcal infection test in a previous pregnancy

  • their maternity care team will offer them antibiotics in labour

• inform the person's GP in writing that there is a risk of group B streptococcal infection in babies in future pregnancies. [2012, amended 2021]

Reassure parents and carers that they will be able to continue caring for and holding their baby according to their wishes, unless the baby is too ill to allow this. If the severity of the baby's illness means they need to change the way they care for the baby, discuss this with them. [2012]

Offer parents and carers contact details of organisations that provide parent support, befriending, counselling, information and advocacy. [2012]

If a baby has been treated for suspected or confirmed neonatal infection:

• advise the parents and carers about potential long-term effects of the baby's illness and likely patterns of recovery, and reassure them if no problems are anticipated

• take account of parents' and carers' concerns when providing information and planning follow-up. [2021]

When a baby who has had a group B streptococcal infection is discharged from hospital:

• advise the woman, trans man or non-binary person that if they become pregnant again:

  • that their new baby will be at increased risk of early-onset group B streptococcal infection

  • they should inform their maternity care team that they have had a previous baby with a group B streptococcal infection

  • their maternity care team will offer them antibiotics in labour

• inform the person's GP in writing that there is a risk of:

  • group B streptococcal infection recurrence in the baby and

  • group B streptococcal infection in babies in future pregnancies. [2012]

Early in the management of confirmed bacterial meningitis, discuss the following with parents and carers:

• what might happen during the course of the disease

• the uncertainty about the initial prognosis, and when they can expect to know more

• the risk of passing on the infection

• whether close contacts need to take any preventative measures (for example, for meningococcal meningitis or Haemophilus influenzae type b). [2024]

Repeat information over time and check the parents and carers understand, as they may be distressed and unable to ask questions when their baby is first diagnosed. [2024]

Provide emotional and pastoral support for family members and carers during hospitalisation. [2024]

Before any baby is transferred home from the hospital or midwifery-led unit (or in the immediate postnatal period in the case of babies born at home), advise parents and carers to seek urgent medical help (for example, from NHS 111, their GP, or an accident and emergency department) if they are concerned that their baby:

• is showing abnormal behaviour (for example, inconsolable crying or listlessness) or

• is unusually floppy or

• has an abnormal temperature unexplained by environmental factors (lower than 36°C or higher than 38°C) or

• has abnormal breathing (rapid breathing, difficulty in breathing or grunting) or

• has a change in skin colour (for example, where the baby becomes very pale, blue/grey or dark yellow) or

• has developed new difficulties with feeding.
  
  Give the advice both in person, and as written information and advice for them to take away. [2021]

When there has been a clinical concern about neonatal infection in a baby, make a post-discharge management plan, taking into account factors such as:

• the level of the initial clinical concern

• the presence of risk factors

• parents' and carers' concerns. [2012]