Summary neonatal_infection_antibiotics_for_prevention_and_treatment

Neonatal infection: antibiotics for prevention and treatment NICE guideline Published: 20 April 2021 Last updated: 19 March 2024 © NICE 2024. All rights reserved. Subject to Notice of rights ( notice-of-rights). Your responsibility The recommendations in this guideline represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, professionals and practitioners are expected to take this guideline fully into account, alongside the individual needs, preferences and values of their patients or the people using their service. It is not mandatory to apply the recommendations, and the guideline does not override the responsibility to make decisions appropriate to the circumstances of the individual, in consultation with them and their families and carers or guardian. All problems (adverse events) related to a medicine or medical device used for treatment or in a procedure should be reported to the Medicines and Healthcare products Regulatory Agency using the Yellow Card Scheme. Local commissioners and providers of healthcare have a responsibility to enable the guideline to be applied when individual professionals and people using services wish to use it. They should do so in the context of local and national priorities for funding and developing services, and in light of their duties to have due regard to the need to eliminate unlawful discrimination, to advance equality of opportunity and to reduce health inequalities. Nothing in this guideline should be interpreted in a way that would be inconsistent with complying with those duties. Commissioners and providers have a responsibility to promote an environmentally sustainable health and care system and should assess and reduce the environmental impact of implementing NICE recommendations wherever possible. Neonatal infection: antibiotics for prevention and treatment (NG195) © NICE 2024. All rights reserved. Subject to Notice of rights ( notice-of-rights). Page 2 of 81 Contents Overview ...................................................................................................................................... 5 Who is it for? ........................................................................................................................................... 5 Recommendations ....................................................................................................................... 6 1.1 Information and support ................................................................................................................... 6 1.2 Preventing early-onset neonatal infection before birth ................................................................ 11 1.3 Risk factors for and clinical indicators of possible early-onset neonatal infection ................... 14 Kaiser Permanente neonatal sepsis calculator ................................................................................... 18 Management for babies at increased risk of infection ....................................................................... 19 1.4 Investigations before starting antibiotics in babies who may have early-onset infection ........ 20 1.5 Antibiotics for suspected early-onset infection ............................................................................ 24 1.6 Duration of antibiotic treatment for early-onset neonatal infection ............................................ 25 1.7 Antibiotic-impregnated intravascular catheters for reducing the risk of late-onset neonatal infection .................................................................................................................................................. 27 1.8 Risk factors for and clinical indicators of possible late-onset neonatal infection ...................... 28 1.9 Investigations before starting antibiotics in babies who may have late-onset infection .......... 30 1.10 Antibiotics for late-onset neonatal infection ................................................................................ 33 1.11 Duration of antibiotic treatment for late-onset neonatal infection ............................................. 34 1.12 Antifungals to prevent fungal infection during antibiotic treatment for late-onset neonatal infection .................................................................................................................................................. 36 1.13 Avoiding routine use of antibiotics in babies ................................................................................ 37 1.14 Early- and late-onset meningitis (babies in neonatal units) ....................................................... 37 1.15 Therapeutic drug monitoring for babies receiving gentamicin ................................................... 44 1.16 Care setting ..................................................................................................................................... 45 1.17 Planning for care after discharge .................................................................................................. 45 Terms used in this guideline .................................................................................................................. 46 Recommendations for research ................................................................................................. 48 Key recommendations for research ..................................................................................................... 48 Other recommendations for research .................................................................................................. 49 Neonatal infection: antibiotics for prevention and treatment (NG195) © NICE 2024. All rights reserved. Subject to Notice of rights ( notice-of-rights). Page 3 of 81 Rationale and impact ................................................................................................................... 53 Information and support ........................................................................................................................ 53 Information and support after diagnosis ............................................................................................. 54 Intrapartum antibiotics .......................................................................................................................... 55 Women with prolonged prelabour rupture of membranes who have group B streptococcal colonisation, bacteriuria or infection .................................................................................................... 57 Risk factors for and clinical indicators of possible early-onset neonatal infection ......................... 58 Lumbar puncture .................................................................................................................................... 61 Cerebrospinal fluid investigations in babies with suspected bacterial meningitis .......................... 62 Antibiotic-impregnated intravascular catheters for reducing the risk of late-onset neonatal infection .................................................................................................................................................. 63 Risk factors for and clinical indicators of possible late-onset neonatal infection ........................... 64 Investigations for late-onset neonatal infection ................................................................................. 66 Antibiotics for late-onset neonatal infection ....................................................................................... 68 Antifungals to prevent fungal infection during antibiotic treatment for late-onset neonatal infection .................................................................................................................................................. 70 Early- and late-onset meningitis (babies in neonatal units) .............................................................. 71 Fluid restriction for confirmed bacterial meningitis ............................................................................ 71 Assessing for immunodeficiency and recurrence risk in babies with bacterial meningitis ............. 72 Identifying and managing complications ............................................................................................. 73 Planning for care after discharge ......................................................................................................... 74 Care after hospital discharge ................................................................................................................ 75 Recurrent bacterial meningitis .............................................................................................................. 76 Context ......................................................................................................................................... 78 Finding more information and committee details ..................................................................... 79 Update information ..................................................................................................................... 80 Neonatal infection: antibiotics for prevention and treatment (NG195) © NICE 2024. All rights reserved. Subject to Notice of rights ( notice-of-rights). Page 4 of 81 This guideline partially replaces CG149. This guideline is the basis of QS75 and QS37. This guideline should be read in conjunction with NG240. Overview This guideline covers preventing bacterial infection in healthy babies of up to and including 28 days corrected gestational age, treating pregnant women whose unborn baby is at risk of infection, and caring for babies of up to and including 28 days corrected gestational age with a suspected or confirmed bacterial infection. It aims to reduce delays in recognising and treating infection and prevent unnecessary use of antibiotics. The guideline does not cover viral infections. The guideline uses the terms 'woman' or 'mother' throughout. These should be taken to include people who do not identify as women but are pregnant or have given birth. Similarly, where the term 'parents' is used, this should be taken to include anyone who has main responsibility for caring for a baby. We recognise there are many different family arrangements. Who is it for? • Healthcare professionals in primary and secondary care • Commissioners and providers of neonatal and maternity services • Parents and carers of babies who are at risk of or who have a neonatal infection Neonatal infection: antibiotics for prevention and treatment (NG195) © NICE 2024. All rights reserved. Subject to Notice of rights ( notice-of-rights). Page 5 of 81 Recommendations Parents and carers have the right to be involved in planning and making decisions about their baby's health and care, and to be given information and support to enable them to do this, as set out in the NHS Constitution and summarised in NICE's information on making decisions about your care. Making decisions using NICE guidelines explains how we use words to show the strength (or certainty) of our recommendations and has information about prescribing medicines (including off-label use), professional guidelines, standards and laws (including on consent and mental capacity), and safeguarding. Please note that the Royal College of Obstetricians and Gynaecologists has produced guidance on COVID-19 and pregnancy for all midwifery and obstetric services. The Royal College of Paediatrics and Child Health has published guidance on COVID-19 for neonatal services. Throughout this guideline, unless otherwise specified, the term neonatal infection covers both early-onset and late-onset infections.