Quality standard

Quality statement 3: Prompt antibiotic treatment for early-onset neonatal infection

Quality statement

Newborn babies who need antibiotic treatment receive it within 1 hour of the decision to treat.

Rationale

If the decision to treat is made, antibiotic treatment for early-onset neonatal infection should be started without delay (and without waiting for test results) and always within 1 hour to improve clinical outcomes for the baby.

Quality measures

Structure

Evidence of local arrangements to ensure that newborn babies who need antibiotic treatment receive it within 1 hour of the decision to treat.

Data source: Local data collection.

Process

Proportion of newborn babies who need antibiotic treatment who receive it within 1 hour of the decision to treat.

Numerator – the number in the denominator who receive antibiotics within 1 hour of the decision to treat.

Denominator – the number of newborn babies who need antibiotic treatment.

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 give antibiotic treatment to newborn babies who need it within 1 hour of the decision to treat.

Healthcare professionals (for example, midwives and doctors) adhere to protocols for antibiotic treatment for newborn babies who need it to be started within 1 hour of the decision to treat and record this.

Commissioners (clinical commissioning groups) specify that maternity care providers give antibiotic treatment to newborn babies who need it within 1 hour of the decision to treat the early-onset neonatal infection.

Newborn babies less than 72 hours old who need antibiotic treatment for an infection receive it within 1 hour.

Source guidance

Neonatal infection: antibiotics for prevention and treatment. NICE guideline NG195 (2021), recommendations 1.3.5 and 1.3.9

Definitions of terms used in this quality statement

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]

Newborn babies who need antibiotic treatment

Babies with any red flag, or with 2 or more 'non-red flag' risk factors or clinical indicators.

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 1.3.5]