Quality statement 5: Information and support for identification of neonatal infection

Quality statement

Parents or carers of newborn babies in whom early‑onset neonatal infection has been a concern are given verbal and written information about neonatal infection before discharge.

Rationale

Prompt identification of neonatal infection is essential to ensure that babies receive appropriate treatment as soon as possible to prevent complications and achieve the best clinical outcomes. Advising parents or carers about what to look for and when to contact a healthcare professional will help them recognise signs of infection promptly and avoid unnecessary delay in treatment of the baby.

Quality measures

Structure

Evidence of local arrangements and protocols to ensure that parents or carers of newborn babies in whom early‑onset neonatal infection has been a concern are given verbal and written information about neonatal infection before discharge.

Data source: Local data collection.

Process

Proportion of parents or carers of newborn babies in whom early‑onset neonatal infection has been a concern who are given verbal and written information about neonatal infection before discharge.

Numerator – the number in the denominator whose parents or carers receive verbal and written information about neonatal infection before discharge.

Denominator – the number of newborn babies in whom early‑onset neonatal infection has been a concern.

Data source: Local data collection.

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

Service providers (secondary care services) ensure that verbal and written information about neonatal infection (including what to look for and who to contact if they are concerned) is available before discharge for parents or carers of newborn babies in whom there have been concerns about early‑onset neonatal infection.

Healthcare professionals discuss neonatal infection with parents or carers of newborn babies in whom there have been concerns about early‑onset neonatal infection, and give them written information before discharge, including what to look for and who to contact if they are concerned.

Commissioners (clinical commissioning groups) specify that services have protocols in place to ensure that verbal and written information about neonatal infection is available for parents or carers of newborn babies in whom there have been concerns about early‑onset neonatal infection. They also ensure that there is access to relevant healthcare professionals for parents or carers who are concerned about neonatal infection.

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

Parents or carers of newborn babies who may be at risk of developing an infection have a healthcare professional discuss this with them and give them written information about infection in newborn babies before they leave hospital. The information should include how to check whether the baby might have an infection and who to contact if they are concerned.

Source guidance

Definitions of terms used in this quality statement

Babies in whom early‑onset neonatal infection is a concern

Babies with any of the risk factors or clinical indicators below, either before birth or during the first 72 hours after birth. Items 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 1.1.1.1]

Discharge

When a baby is discharged from the hospital or midwifery‑led unit or in the immediate postnatal period if the baby is born at home. [Adapted from Antibiotics for early-onset neonatal infection (NICE guideline CG149) recommendation 1.1.1.9].

Information about neonatal infection

Verbal and written information for parents and carers that they should seek medical advice (for example, from NHS Direct, their GP or an accident and emergency department) if they are concerned that the baby:

  • is showing abnormal behaviour (for example, inconsolable crying or listlessness) or

  • is unusually floppy or

  • has developed difficulties with feeding or with tolerating feeds or

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

  • has rapid breathing or

  • has a change in skin colour.

[Antibiotics for early-onset neonatal infection (NICE guideline CG149) recommendation 1.1.1.8]

Equality and diversity considerations

Information about neonatal infection should be accessible to parents or carers with additional needs such as physical, sensory or learning disabilities, and to parents or carers who do not speak or read English. Parents or carers of babies in whom early‑onset neonatal infection has been a concern in any setting should have access to an interpreter or advocate if needed.