Introduction

This quality standard covers the use of antibiotics to prevent and treat infection in newborn babies (both term and preterm) from birth to 28 days in primary (including community) and secondary care. It includes antibiotics that are given to newborn babies or to mothers during intrapartum care to prevent neonatal infection (antibiotic prophylaxis). For more information see the topic overview.

Why this quality standard is needed

Neonatal infection is a significant cause of mortality and morbidity in newborn babies. It may be early-onset (infection arising within 72 hours of birth) or late-onset (infection arising more than 72 hours after birth). Neonatal infection can lead to life-threatening sepsis and accounts for 10% of all neonatal mortality. Early-onset neonatal infection, although less common than late-onset neonatal infection, is often more severe.

Neonatal infection is present in 8 of every 1000 live births and 71 of every 1000 neonatal admissions. Of these infections, 82% occur in premature babies (less than 37 weeks) and 81% in low birthweight babies (below 2500 grams).

Early-onset neonatal infection is present in 0.9 of every 1000 live births and 9 of every 1000 neonatal admissions. Group B Streptococcus and Escherichia coli are the most common organisms identified, accounting for 58% and 18% of infections respectively.

Late-onset neonatal infection is present in 7 of every 1000 live births and 61 of every 1000 neonatal admissions. Coagulase‑negative staphylococci, Enterobacteriaceae and Staphylococcus aureus are the most common organisms identified, accounting for 54%, 21% and 18% of infections respectively.

Prompt antibiotic treatment for neonatal infection can save lives. However, most newborn babies who are given antibiotics do not have any infection. Antibiotics given in the first few days after birth may increase the risk of conditions such as eczema and asthma in later life, but these risks cannot be quantified. Widespread antibiotic use may also be associated with a risk of antimicrobial resistance. For these reasons, babies should have minimal exposure to antibiotics.

The quality standard is expected to contribute to improvements in the following outcomes:

  • infant mortality

  • admissions and readmissions to neonatal care units

  • maternity and neonatal length of hospital stay

  • neonatal neurological and auditory development.

How this quality standard supports delivery of outcome frameworks

NICE quality standards are a concise set of prioritised statements designed to drive measurable quality improvements within a particular area of health or care. They are derived from high-quality guidance, such as that from NICE or other sources accredited by NICE. This quality standard, in conjunction with the guidance on which it is based, should contribute to the improvements outlined in the following 2 outcomes frameworks published by the Department of Health:

Tables 1 and 2 show the outcomes, overarching indicators and improvement areas from the frameworks that the quality standard could contribute to achieving.

Table 1 NHS Outcomes Framework 2014/15

Domain

Overarching indicators and improvement areas

1 Preventing people from dying prematurely

Overarching indicator

1a Potential Years of Life Lost (PYLL) from causes considered amenable to healthcare

ii Children and young people

Improvement area

Reducing deaths in babies and young children

1.6 ii Neonatal mortality and stillbirths

4 Ensuring that people have a positive experience of care

Overarching indicator

4b Patient experience of hospital care

Improvement area

Improving women and their families' experience of maternity services

4.5 Women's experience of maternity services

5 Treating and caring for people in a safe environment and protecting them from avoidable harm

Overarching indicators

5a Patient safety incidents reported

5b Safety incidents involving severe harm or death

5c Hospital deaths attributable to problems in care

Improvement areas

Reducing the incidence of avoidable harm

5.2 Incidence of healthcare associated infection (HCAI)

i MRSA

5.4 Incidence of medication errors causing serious harm

Improving the safety of maternity services

5.5 Admission of full‑term babies to neonatal care

Delivering safe care to children in acute settings

5.6 Incidence of harm to children due to 'failure to monitor'

Table 2 Public health outcomes framework for England, 2013–2016

Domain

Objectives and indicators

4 Healthcare public health and preventing premature mortality

Objective

Reduced numbers of people living with preventable ill health and people dying prematurely, while reducing the gap between communities

Indicator

4.3 Mortality rate from causes considered preventable** (NHSOF 1a)

Alignment across the health and social care system

** Indicator complementary with NHS Outcomes Framework (NHSOF)

Patient experience and safety issues

Ensuring that care is safe and that people have a positive experience of care is vital in a high‑quality service. It is important to consider these factors when planning and delivering services relevant to antibiotics for neonatal infection.

Coordinated services

The quality standard for antibiotics for neonatal infection specifies that services should be commissioned from and coordinated across all relevant agencies encompassing the whole neonatal care pathway. A person‑centred, integrated approach to providing services is fundamental to delivering high‑quality care to pregnant women and babies who are at risk of or who have a neonatal infection (within 28 days of birth) in primary (including community) and secondary care.

The Health and Social Care Act 2012 sets out a clear expectation that the care system should consider NICE quality standards in planning and delivering services, as part of a general duty to secure continuous improvement in quality. Commissioners and providers of health and social care should refer to the library of NICE quality standards when designing high‑quality services. Other quality standards that should also be considered when choosing, commissioning or providing a high‑quality neonatal infection service are listed in related quality standards.

Training and competencies

The quality standard should be read in the context of national and local guidelines on training and competencies. All healthcare professionals involved in assessing, caring for and treating pregnant women and babies who are at risk of or who have a neonatal infection (within 28 days of birth) in primary (including community) and secondary care should have sufficient and appropriate training and competencies to deliver the actions and interventions described in the quality standard. Quality statements on staff training and competency are not usually included in quality standards. However, recommendations in the development source on specific types of training for the topic that exceed standard professional training are considered during quality statement development.

Role of parents and carers

The quality standard recognises the key role parents and carers have in identifying and caring for babies who are at risk of or who have a neonatal infection (within 28 days of birth) in primary (including community) and secondary care. Healthcare professionals should ensure that parents or carers are involved in the decision‑making process about investigations, treatment and care.