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 service providers, healthcare professionals and commissioners

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 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.

What the quality statement means for patients, service users and carers

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

Source guidance

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. Risk factors and clinical indicators below marked [red flag] prompt a high level of concern.

Risk factors
  • invasive group B streptococcal infection in a previous baby

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

  • prelabour rupture of membranes

  • preterm birth following spontaneous labour (before 37 weeks' gestation)

  • suspected or confirmed rupture of membranes for more than 18 hours in a preterm birth

  • intrapartum fever higher than 38°C, or confirmed or suspected chorioamnionitis

  • parenteral antibiotic treatment given to the woman for confirmed or suspected invasive bacterial infection (such as septicaemia) at any time during labour, or in the 24‑hour periods before and after the birth (this does not refer to intrapartum antibiotic prophylaxis) [red flag]

  • suspected or confirmed infection in another baby in the case of a multiple pregnancy [red flag].

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

  • respiratory distress starting more than 4 hours after birth [red flag]

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

  • jaundice within 24 hours of birth

  • apnoea

  • signs of neonatal encephalopathy

  • seizures [red flag]

  • need for cardiopulmonary resuscitation

  • need for mechanical ventilation in a preterm baby

  • need for mechanical ventilation in a term baby [red flag]

  • persistent fetal circulation (persistent pulmonary hypertension)

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

  • signs of shock [red flag]

  • unexplained excessive bleeding, thrombocytopenia, or abnormal coagulation (international normalised ratio greater than 2.0)

  • oliguria persisting beyond 24 hours after birth

  • altered glucose homeostasis (hypoglycaemia or hyperglycaemia)

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

  • local signs of infection (for example, affecting the skin or eye).

[Adapted from Antibiotics for early-onset neonatal infection (NICE guideline CG149) recommendation 1.2.3.1]

Newborn babies

Babies under 72 hours old. [Adapted from Antibiotics for early-onset neonatal infection (NICE guideline CG149)]