NICE calls for better assessment and treatment of babies at risk of infection

The National Institute for Health and Clinical Excellence (NICE) in the US today opened public consultation on its draft guideline on the use of antibiotics for the prevention and treatment of early-onset (within 72 hours of birth) neonatal infection. The draft guideline sets out preliminary recommendations on how the risk of neonatal infection should be assessed, the appropriate investigations for early-onset neonatal infection, when antibiotics should and should not be used, the selection of appropriate antibiotics and how long they should be given for the prevention and treatment of infection.

Early-onset neonatal bacterial infection, although less common than late-onset infection, is a significant cause of mortality and morbidity in newborn babies. It is often severe and is the cause of death in over 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.

Exposure to GBS is common in newborn babies and, although most babies do not develop GBS infection, it is the leading cause of early-onset bacteraemia in the UK and has an overall mortality rate of around 10 per cent - higher in premature babies and babies with a very low birth weight. It is also an important factor in the development of small areas of damage to the surface of the brain and subsequent neurodevelopmental delay.

Areas covered by the draft recommendations include: how to recognise risk factors for neonatal infection; signs and symptoms, including 'red flags', for possible neonatal infection; a framework to direct clinical action in babies at increased risk of infection; the timing and duration of antibiotic treatment, including antibiotic treatment regimens for confirmed and suspected meningitis for babies in neonatal care units, investigations during antibiotic treatment and the information and support that should be provided to parents or carers where there are any clinical concerns about possible early-onset neonatal infection.

Dr Fergus Macbeth, director of the Centre for Clinical Practice at NICE, said, "Prompt antibiotic treatment for neonatal infection can save lives. However, the care of babies at risk of infection is variable, with many receiving antibiotics, perhaps unnecessarily, and with some neonatologists treating bacterial colonisation more readily than others. There is also concern that the range of effective antibiotics is being reduced by the development of bacterial resistance as a result of unnecessary antibiotic prescribing. This guideline will provide the NHS with the blueprint for an approach that prioritises the treatment of sick babies, minimises the impact of management pathways on healthy women and babies and uses antibiotics wisely to avoid the development of resistance to antibiotics."

Stakeholders have until 27 February 2012 to comment on the recommendations in the draft guideline. Organisations can register as stakeholders at any time during the development of the guideline and comments must be submitted via the NICE website. The final recommendations could change depending on feedback received during the development of this guideline.