Quality standard

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 different audiences

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 (for example, midwives and doctors) 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.

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

Neonatal infection: antibiotics for prevention and treatment. NICE guideline NG195 (2021), recommendations 1.1.2, 1.1.5 and 1.1.12

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. Red flag risk factors and clinical indicators prompt a high level of concern.

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).

[Adapted from NICE's guideline on neonatal infection, recommendations 1.1.2, 1.1.5, 1.3.3 and 1.3.4]

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. [NICE's guideline on neonatal infection, recommendation 1.1.5].

Information about neonatal infection

Verbal and written information for parents and carers that they should seek urgent medical help (for example, from NHS 111, 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 an abnormal temperature unexplained by environmental factors (lower than 36°C or higher than 38°C) or

  • has abnormal breathing (rapid breathing, difficulty in breathing or grunting) or

  • has a change in skin colour (for example where the baby becomes very pale, blue/grey or dark yellow) or

  • has developed new difficulties with feeding.

[NICE's guideline on neonatal infection, recommendation 1.1.12]

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.