Quality standard

Quality statement 5: Information and support for parents and carers

Quality statement 5: Information and support for parents and carers

Quality statement

Parents or carers of babies that have or have had risk factors for neonatal infection, or whose baby has received intravenous antibiotics, are given verbal and written information about neonatal infection before transfer to community care, before the midwife leaves after a home birth or before discharge. [2014, updated 2024]

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 treating the baby.

Quality measures

The following measures can be used to assess the quality of care or service provision specified in the statement. They are examples of how the statement can be measured, and can be adapted and used flexibly.

Process

Proportion of parents or carers of babies that have or have had risk factors for neonatal infection, or where their baby has received intravenous (IV) antibiotics, who are given verbal and written information about neonatal infection before transfer to community care, before the midwife leaves after a home birth or before discharge.

Numerator – the number in the denominator whose parents or carers receive verbal and written information about neonatal infection before transfer to community care, before the midwife leaves after a home birth or before discharge.

Denominator – the number of babies that have or have had risk factors for neonatal infection, or who have received IV antibiotics.

Data source: Data can be collected from information recorded locally by healthcare professionals and provider organisations, for example from patient records and audits of parental experience.

What the quality statement means for different audiences

Service providers (maternity and neonatal services) ensure that verbal and written information about neonatal infection, including what signs and symptoms to look for and who to contact if they are concerned, is given to parents or carers of babies who have or have had risk factors for neonatal infection or have received IV antibiotics. The information should be given before transfer to community care, before the midwife leaves after a home birth or before discharge and should also include information on organisations and groups they can contact if they need support.

Healthcare professionals (midwives, neonatal nurses, neonatologists and paediatricians) discuss neonatal infection with parents or carers of babies who have or have had risk factors for neonatal infection or have received IV antibiotics, and give them written information, including what signs and symptoms to look for and who to contact if they are concerned. This information is given before transfer to community care, before the midwife leaves after a home birth or before discharge.

Commissioners ensure that maternity and neonatal services provide verbal and written information about neonatal infection to parents or carers of babies who have or have had risk factors for neonatal infection or have received IV antibiotics.

Parents or carers of babies (up to 28 days corrected gestational age) who have or have had risk factors for infection, or who have received intravenous antibiotics, are given written information about infection in babies before the midwife leaves if the baby was born at home or before they leave hospital. Their baby's healthcare professional will also discuss this with them. The information should include how to check if the baby might have an infection and who to contact if they are concerned. This should also include information on organisations and groups they can contact if they need support.

Source guidance

Neonatal infection: antibiotics for prevention and treatment. NICE guideline NG195 (2021), recommendations 1.1.2, 1.1.5 and 1.1.15

Definitions of terms used in this quality statement

Risk factors for neonatal infection

Risk factors for neonatal infection include:

  • the pregnant woman or pregnant person having:

    • group B streptococcal colonisation, bacteriuria or infection during the current pregnancy, or

    • group B streptococcal colonisation, bacteriuria or infection in a previous pregnancy, and no negative test for group B streptococcus by enrichment culture or PCR on a rectovaginal swab sample collected between 35 and 37 weeks' gestation or 3 to 5 weeks before the anticipated delivery date in the current pregnancy, or

    • a previous baby with an invasive group B streptococcal infection, or

    • a clinical diagnosis of chorioamnionitis

  • preterm birth

  • the baby needing or having had mechanical ventilation

  • the baby having a history of surgery

  • the baby having central catheter

  • infection in another baby from a multiple birth.

[NICE's guideline on neonatal infection, recommendations 1.2.1 and 1.8.1]

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 (less than 36°C or more than 38°C), or

  • has abnormal breathing (rapid breathing, difficulty 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.

In addition, if parents are concerned that their baby is unwell but they do not have any of the symptoms listed, the verbal and written information they are given should encourage them to seek urgent medical help. This includes any change of skin colour from the baby's usual skin colour. [NICE's guideline on neonatal infection, recommendation 1.1.15 and expert opinion]

Equality and diversity considerations

One of the symptoms of neonatal infection that should be included in the information to parents is a change in skin colour (for example, where the baby becomes very pale, blue/grey or dark yellow). It is important that the information clearly explains how this symptom may present differently on babies depending on their skin colour, and how best to identify changes in skin colour on different skin tones, such as where on the body to look for changes in colour. It could also include links to any resources that can help parents identify a change in colour in their baby, such as Symptom spotting on darker skin tones, developed by Bliss. This resource has not been produced by NICE and is not maintained by NICE. NICE has not made any judgement about the quality and usability of the resource. Other resources may also be available.

Parents and carers should be provided with information about neonatal infection that they can easily read and understand themselves, or with support, so they can communicate effectively with healthcare services. Information should be in a format that suits their needs and preferences. It should be accessible to people who do not speak or read English, and it should be culturally appropriate. People should have access to an interpreter or advocate if needed.

For people with additional needs related to a disability, impairment or sensory loss, information should be provided as set out in NHS England's Accessible Information Standard or the equivalent standards for the devolved nations.