WIREDGOV

The NHS should prioritise the treatment of babies with suspected early-onset neonatal infection and use antibiotics sensibly to avoid developing resistance to the drugs, according to latest NICE guidance.

Early-onset neonatal bacterial infection, infection that occurs within 72 hours of birth, is the cause of death for 1 in 4 babies who develop it, even when they are given antibiotics.

These infections are usually caused by organisms from the mother's genital tract, including group B Streptococcus (GBS), E.coli, Pseudomonas and Klebsiella.

Such infections may develop suddenly and rapidly, with mortality particularly high in premature babies and those with a low birth weight. They may also lead to the development of cortical lesions in the brain, and so subsequently cause neuro-developmental delay.

Currently, there are unnecessary delays in recognising and treating sick babies and wide variation in how the risk of early-onset neonatal infection is managed in healthy babies.

The latest advice from NICE aims to address this by setting out a framework based on risk factors and clinical indicators should be used to identify and treat babies with an increased likelihood of having an early-onset neonatal infection.

NICE recommends that intrapartum antibiotic prophylaxis should be offered in a timely manner to women whose babies are at higher risk of infection. This includes women who have had a previous baby with an invasive group B streptococcal infection, or a group B streptococcal colonisation, bacteriuria or infection in the current pregnancy.

Babies with suspected early-onset neonatal infection should receive antibiotics as quickly as possible, within 1 hour of the decision to treat.

Benzylpenicillin and gentamicin should be used in combination as the first-choice antibiotic regimen for treating suspected early onset neonatal infection.

Antibiotic use should be minimised in babies who are suspected of having an early-onset neonatal infection, but subsequently do not.

Professor Mark Baker, Director of the Centre for Clinical Practice at NICE said: “Early onset neonatal infection can be very serious and, at present, there is much variation in how it is managed, with sometimes unnecessary delays in recognising and treating sick babies.

“Many babies are receiving antibiotics needlessly, and consequently, there is concern that the effectiveness of antibiotics is being reduced because of the development of resistance to them. I am sure this new guideline will be welcomed as a useful tool for all those healthcare professionals working in this area.”

Mark Turner, Senior Lecturer and Consultant in Neonatology, University of Liverpool and Liverpool Women's NHS Foundation Trust and chair of the guideline development group responsible for the guidance added: “The NHS needs to prioritise treatment for sick babies as well as ensure antibiotics are used sensibly.”

A range of support tools have been developed to help put this guidance into practice including a podcast, a parent information leaflets, and a shared learning example: Supporting a 36 hour Neonatal Blood Culture status check by developing the availability of blood culture status in real time.