Key priorities for implementation

The following recommendations have been identified as priorities for implementation.

Information and support

  • If there have been any concerns about early-onset neonatal infection before a baby is discharged, advise the parents and carers verbally and in writing that they should seek medical advice (for example, from NHS Direct, their general practice, or an accident and emergency department) if they are concerned that the baby:

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

    • is unusually floppy, or

    • has developed difficulties with feeding or with tolerating feeds, or

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

    • has rapid breathing, or

    • has a change in skin colour.

Risk factors for infection and clinical indicators of possible infection

  • Use the following framework based on risk factors and clinical indicators, including red flags (see tables 1 and 2), to direct antibiotic management decisions:

    • In babies with any red flags, or with two or more 'non-red flag' risk factors or clinical indicators (see tables 1 and 2), perform investigations (see recommendations 1.5.1.1–1.5.1.3) and start antibiotic treatment. Do not delay starting antibiotics pending the test results (see recommendations 1.6.1.1–1.6.1.3).

    • In babies without red flags and only one risk factor or one clinical indicator, using clinical judgement, consider:

      • whether it is safe to withhold antibiotics, and

      • whether it is necessary to monitor the baby's vital signs and clinical condition – if monitoring is required continue it for at least 12 hours (at 0, 1 and 2 hours and then 2-hourly for 10 hours).

  • If a baby needs antibiotic treatment it should be given as soon as possible and always within 1 hour of the decision to treat.

Intrapartum antibiotics

  • Offer intrapartum antibiotic prophylaxis using intravenous benzylpenicillin to prevent early-onset neonatal infection for women who have had:

    • a previous baby with an invasive group B streptococcal infection

    • group B streptococcal colonisation, bacteriuria or infection in the current pregnancy.

Investigations before starting antibiotics in the baby

  • Measure the C-reactive protein concentration at presentation when starting antibiotic treatment in babies with risk factors for infection or clinical indicators of possible infection.

Antibiotics for suspected infection

  • Use intravenous benzylpenicillin with gentamicin as the first-choice antibiotic regimen for empirical treatment of suspected infection unless microbiological surveillance data reveal local bacterial resistance patterns indicating a different antibiotic.

Investigations during antibiotic treatment

  • In babies given antibiotics because of risk factors for infection or clinical indicators of possible infection, measure the C-reactive protein concentration 18–24 hours after presentation.

Decisions 36 hours after starting antibiotic treatment

  • In babies given antibiotics because of risk factors for infection or clinical indicators of possible infection consider stopping the antibiotics at 36 hours if:

    • the blood culture is negative, and

    • the initial clinical suspicion of infection was not strong, and

    • the baby's clinical condition is reassuring with no clinical indicators of possible infection, and

    • the levels and trends of C-reactive protein concentration are reassuring.

  • Consider establishing hospital systems to provide blood culture results 36 hours after starting antibiotics to facilitate timely discontinuation of treatment and discharge from hospital.

Care setting

  • When deciding on the appropriate care setting for a baby, take into account the baby's clinical needs and the competencies necessary to ensure safe and effective care (for example, the insertion and care of intravenous cannulas).

  • National Institute for Health and Care Excellence (NICE)