Quality standard
Quality statement 4: Reassessing antibiotic treatment for neonatal infection
Quality statement 4: Reassessing antibiotic treatment for neonatal infection
Quality statement
Neonates who start intravenous antibiotic treatment for suspected neonatal infection have their need for it reassessed at 36 hours for early-onset or at 48 hours for late-onset. [2014, updated 2024]
Rationale
Neonates should have their intravenous (IV) antibiotic treatment reassessed to ensure that they are not receiving antibiotics unnecessarily. Reassessment, including consideration of any blood test results, is needed so that antibiotic treatment can be stopped if there are clinical indications that a neonate does not have an infection. If antibiotic treatment needs to be continued, it will also ensure the correct antibiotics can be given, based on the blood culture findings. In both cases, this will help improve safety by reducing the likelihood of local antimicrobial resistance, as well as improving the experience of the postnatal period for these babies and their parents or carers.
The timescale for review is later for late-onset infection because it may be caused by different bacteria. Some of these may grow more slowly, and it can take longer for a blood culture to become positive. This means treatment needs to continue for longer until a negative blood culture result can be confirmed.
Quality measures
The following measures can be used to assess the quality of care or service provision specified in the statement. They are examples of how the statement can be measured, and can be adapted and used flexibly.
Structure
Evidence that hospitals and laboratories have systems in place to return blood culture results within 36 hours of bloods being taken for early-onset neonatal infection, and within 48 hours of bloods being taken for late-onset neonatal infection.
Data source: Evidence can be collected locally from service level agreements and pathways.
Process
a) Proportion of neonates who start IV antibiotic treatment for suspected early-onset neonatal infection who have their need for it reassessed at 36 hours.
Numerator – the number in the denominator who have their need for antibiotic treatment reassessed at 36 hours.
Denominator – the number of neonates who start IV antibiotic treatment for suspected early-onset neonatal infection.
Data source: Data can be collected from information recorded locally by healthcare professionals and provider organisations, for example from patient records.
b) Proportion of neonates who start IV antibiotic treatment for suspected late-onset neonatal infection who have their need for it reassessed at 48 hours.
Numerator – the number in the denominator who have their need for antibiotic treatment reassessed at 48 hours.
Denominator – the number of neonates who start IV antibiotic treatment for suspected late-onset neonatal infection.
Data source: Data can be collected from information recorded locally by healthcare professionals and provider organisations, for example from patient records.
What the quality statement means for different audiences
Service providers (maternity, paediatric, neonatal and laboratory services) have protocols in place to ensure that healthcare professionals reassess IV antibiotic treatment for early-onset neonatal infection at 36 hours and for late-onset neonatal infection at 48 hours. They ensure there are systems in place for blood culture results to be returned within these timescales to allow the reassessment to take place.
Healthcare professionals (for example, midwives, neonatal nurses, microbiologists, paediatricians and neonatologists) reassess the need for IV antibiotic treatment for early-onset neonatal infection at 36 hours and for late-onset neonatal infection at 48 hours. They stop antibiotic treatment at that time if there are clinical indications that a baby does not have an infection. If further antibiotic treatment is needed, the most appropriate antibiotics can be given based on the blood culture findings. If antibiotics are continued, the need for them is reassessed every 24 hours until they are stopped.
Commissioners ensure that maternity, paediatric, neonatal and laboratory providers reassess the need for IV antibiotic treatment for early-onset neonatal infection at 36 hours and for late-onset neonatal infection at 48 hours, taking blood culture results into account.
Neonates (babies up to 28 days corrected gestational age) receiving intravenous antibiotic treatment for suspected neonatal infection have their treatment checked to see if they need to continue it. If they are receiving antibiotic treatment for suspected early-onset neonatal infection, this check will take place 36 hours after they started treatment. If they are receiving antibiotic treatment for suspected late-onset neonatal infection, this check will take place 48 hours after they started treatment. If they carry on receiving antibiotics after this, their need for them will be reassessed every 24 hours until they are stopped.
Source guidance
Neonatal infection: antibiotics for prevention and treatment. NICE guideline NG195 (2021), recommendations 1.6.3 and 1.11.3
Definitions of terms used in this quality statement
Neonates
Babies of up to and including 28 days corrected gestational age. [NICE's guideline on neonatal infection, overview]
Reassessment of the need for intravenous antibiotic treatment
This includes blood culture, C-reactive protein level, clinical condition and the strength of the initial clinical suspicion of infection. Antibiotic treatment may be stopped if blood culture is negative, initial suspicion of infection was not strong, the baby has no clinical indicators of infection, and the levels and trends of C-reactive protein concentrations are reassuring. [NICE's guideline on neonatal infection, recommendations 1.6.3 and 1.11.3]