Early Onset Neonatal Infection: Review of Antibiotic Guideline in Practice

Background: National Institute of Clinical Excellence (NICE) implemented a guideline which is well used in Neonatal departments to prevent infection within 72 hours of life for healthy babies. “It aims to reduce delay in recognising and treating sick babies and prevent unnecessary use of antibiotics.”

Objective: To review practice for well, term babies who are started on antibiotics due to risk factors as suggested by NICE.

Methods: Data was collected retrospectively over a six month period from October 2018 to March 2019 at St George’s Hospital, a tertiary neonatal service in London, UK. All well asymptomatic babies ≥37 weeks gestation, started on antibiotics due to risk factors were included. Of these we reviewed which:

• Met NICE criteria
• Had laboratory evidence of infection, indicated by C reactive protein (CRP) rise ≥10
• Had clinically significant culture results – blood or CSF

All babies who were admitted to the neonatal unit were excluded.

Results: A total of 149 babies were included. 104 of these met NICE criteria for screening. Of these, 53 (51%, 36% of total) had a CRP rise of ≥10, none had a positive culture. 45 babies did not meet the criteria, of these 24 (53%, 16% of total) had a CRP rise and one had a positive culture.

Conclusion: Only half of babies who met the criteria had a CRP rise, none of these babies had a positive culture. Half of the babies who did not meet the criteria, but were still screened had a CRP rise and one baby had a positive culture. This audit recommends a call to review the guideline as despite not meeting criteria babies are still being treated for and are found to have signs of infection. There also remains a large proportion of well babies who receive antibiotics and remain in hospital unnecessarily.