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. Data can be collected using NICE's empirical treatment of suspected infection clinical audit tool, audit standard 3.

What the quality statement means for service providers, healthcare professionals and commissioners

Service providers (maternity care services) develop protocols to ensure that healthcare professionals give antibiotic treatment within 1 hour of the decision to treat.

Healthcare professionals adhere to protocols for antibiotic treatment 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.

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

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

Source guidance

Definitions of terms used in this quality statement

Newborn babies

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

Newborn babies who need antibiotic treatment

Babies with 2 or more of the risk factors listed below, and babies with any risk factor marked [red flag].

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

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

  • pre‑labour 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 1.2.3.2]