Quality standard

Quality statement 2: Clinical assessment for early-onset neonatal infection

Quality statement

Pregnant women and newborn babies receive a comprehensive clinical assessment for the risks or indicators of early-onset neonatal infection.

Rationale

A comprehensive clinical assessment can identify babies who are at increased risk, or showing signs, of possible early-onset neonatal infection and enable healthcare professionals to start antibiotic treatment promptly if needed.

Quality measures

Structure

Evidence of local arrangements and written protocols to ensure that pregnant women and newborn babies receive a comprehensive clinical assessment for the risks or indicators of early-onset neonatal infection.

Data source: Local data collection.

Process

a) Proportion of pregnant women who are assessed for risk factors for early-onset neonatal infection.

Numerator – the number in the denominator who are assessed for risk factors for early-onset neonatal infection.

Denominator – the number of pregnant women.

Data source: Local data collection.

b) Proportion of newborn babies who are assessed for clinical indicators of early-onset neonatal infection.

Numerator – the number in the denominator who are assessed for clinical indicators of early-onset neonatal infection.

Denominator – the number of newborn babies.

Data source: Local data collection.

c) Proportion of newborn babies with risk factors or clinical indicators of early-onset neonatal infection who receive an immediate physical examination including an assessment of the vital signs.

Numerator – the number in the denominator who receive an immediate physical examination including an assessment of the vital signs.

Denominator – the number of newborn babies identified with risk factors or clinical indicators of early-onset neonatal infection.

Data source: Local data collection.

What the quality statement means for different audiences

Service providers (maternity care services) develop protocols to ensure that healthcare professionals are trained to identify the risk factors and clinical indicators of early-onset neonatal infection and perform a physical examination of the baby (including an assessment of the vital signs) if any have been identified.

Healthcare professionals (for example, midwives and doctors) monitor for risk factors and clinical indicators of early-onset neonatal infection and perform an immediate physical examination of the baby (including an assessment of the vital signs) if any have been identified.

Commissioners (clinical commissioning groups) specify that maternity care providers develop and adhere to protocols to support the identification of risk factors and clinical indicators of early-onset neonatal infection and perform immediate physical assessments of newborn babies if any have been identified.

Pregnant women and newborn babies have an assessment to check whether the baby is at risk of infection.

Source guidance

Neonatal infection: antibiotics for prevention and treatment. NICE guideline NG195 (2021), recommendations 1.3.1, 1.3.2, and 1.3.3

Definitions of terms used in this quality statement

Comprehensive clinical assessment

Comprehensive clinical assessment for early-onset neonatal infection is a continuing process that begins before the baby is born and continues until 72 hours after the birth. It includes identifying whether there are any risk factors or clinical indicators for early-onset neonatal infection and performing a physical examination of the baby (including an assessment of the vital signs) without delay if any are identified. Red flag risk factors and clinical indicators (defined below) prompt a high level of concern. [Expert opinion]

Risk factors

Red flag risk factor:

  • Suspected or confirmed infection in another baby in the case of a multiple pregnancy.

Other risk factors:

  • Invasive group B streptococcal infection in a previous baby or maternal group B streptococcal colonisation, bacteriuria or infection in the current pregnancy.

  • Preterm birth following spontaneous labour before 37 weeks' gestation.

  • Confirmed rupture of membranes for more than 18 hours before a preterm birth.

  • Confirmed prelabour rupture of membranes at term for more than 24 hours before the onset of labour.

  • Intrapartum fever higher than 38°C if there is suspected or confirmed bacterial infection.

  • Clinical diagnosis of chorioamnionitis.

Clinical indicators

Red flag clinical indicators:

  • Apnoea (temporary stopping of breathing)

  • Seizures

  • Need for cardiopulmonary resuscitation

  • Need for mechanical ventilation

  • Signs of shock.

Other clinical indicators:

  • Altered behaviour or responsiveness

  • Altered muscle tone (for example, floppiness)

  • Feeding difficulties (for example, feed refusal)

  • Feed intolerance, including vomiting, excessive gastric aspirates and abdominal distension

  • Abnormal heart rate (bradycardia or tachycardia)

  • Signs of respiratory distress (including grunting, recession, tachypnoea)

  • Hypoxia (for example, central cyanosis or reduced oxygen saturation level)

  • Persistent pulmonary hypertension of newborns

  • Jaundice within 24 hours of birth

  • Signs of neonatal encephalopathy

  • Temperature abnormality (lower than 36°C or higher than 38°C) unexplained by environmental factors

  • Unexplained excessive bleeding, thrombocytopenia, or abnormal coagulation

  • Altered glucose homeostasis (hypoglycaemia or hyperglycaemia)

  • Metabolic acidosis (base deficit of 10 mmol/litre or greater).

[NICE's guideline on neonatal infection, recommendation 1.3.3]

Newborn babies

Babies under 72 hours old. [Adapted from NICE's guideline on neonatal infection, terms used in this guideline definition of early-onset neonatal infection]