Quality statement 4: Reassessing antibiotic treatment for early‑onset neonatal infection

Quality statement

Newborn babies who start antibiotic treatment for possible early‑onset neonatal infection have their need for it reassessed at 36 hours.

Rationale

Newborn babies should have their antibiotic treatment reassessed 36 hours after starting treatment to ensure that they are not receiving antibiotics unnecessarily. Reassessment (including consideration of any blood test results) is needed so that antibiotic treatment can be stopped if there are clinical indications that a baby does not have an infection. This will help to improve safety by reducing the likelihood of local antimicrobial resistance as well as improve the experience of the postnatal period for these babies and their parents or carers.

Quality measures

Structure

Evidence of local arrangements to ensure that newborn babies who start antibiotic treatment for possible early‑onset neonatal infection have their need for it reassessed at 36 hours.

Data source: Local data collection.

Process

Proportion of newborn babies who start antibiotic treatment for possible early‑onset neonatal infection who have their need for it reassessed at 36 hours.

Numerator – the number in the denominator who have their need for antibiotic treatment reassessed at 36 hours.

Denominator – the number of newborn babies who start antibiotic treatment for possible 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) have protocols in place to ensure that healthcare professionals reassess antibiotic treatment at 36 hours, and have systems in place for blood culture results to be returned within 36 hours.

Healthcare professionals adhere to protocols and reassess the need for antibiotic treatment at 36 hours to enable antibiotic treatment to be stopped if there are clinical indications that a baby does not have an infection.

Commissioners (clinical commissioning groups) specify that maternity care providers reassess the need for antibiotic treatment at 36 hours and include consideration of blood culture results.

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

Newborn babies being given antibiotic treatment for an infection have their treatment checked at 36 hours to see whether they need to continue it.

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)]

Reassessment of the need for antibiotic treatment

Includes blood culture, C‑reactive protein level, clinical condition and the strength of the initial clinical suspicion of infection. Antibiotic treatment may be stopped if blood culture is negative, initial suspicion of infection was not strong, the baby has no clinical indicators of infection and C‑reactive protein levels are reassuring. [NICE guideline CG149, recommendation 1.7.2.1]

Hospitals should consider establishing systems to provide blood culture results 36 hours after starting antibiotic treatment to facilitate the timely discontinuation of treatment. [Adapted from Antibiotics for early-onset neonatal infection (NICE guideline CG149) recommendation 1.7.2.2]