Quality standard
Quality statement 3: Prompt antibiotic treatment for neonatal infection
Quality statement 3: Prompt antibiotic treatment for neonatal infection
Quality statement
Neonates who need intravenous antibiotic treatment for suspected neonatal infection receive it within 1 hour of the decision to treat. [2014, updated 2024]
Rationale
If the decision to treat is made, intravenous (IV) antibiotic treatment for neonatal infection should be started without delay, without waiting for test results. This should be as soon as possible and always within 1 hour to improve clinical outcomes for the baby. Most cases of early-onset and late-onset neonatal infection are identified in hospital. For babies with suspected neonatal infection identified outside the hospital setting, the decision to treat with IV antibiotics would be made on admission to hospital.
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 neonates who need IV antibiotic treatment for suspected neonatal infection who receive it within 1 hour of the decision to treat.
Numerator – the number in the denominator who receive IV antibiotic treatment for suspected neonatal infection within 1 hour of the decision to treat.
Denominator – the number of neonates where a decision to treat with IV antibiotic treatment for suspected neonatal infection has been made.
Data source: Data can be collected from information recorded locally by healthcare professionals and provider organisations, for example from patient records.
What the quality statement means for different audiences
Service providers (primary, community, maternity, paediatric and neonatal services) ensure that healthcare professionals can administer IV antibiotic treatment for suspected neonatal infection to neonates as soon as possible and always within 1 hour of the decision to treat. This includes having healthcare professionals available who are trained to obtain venous access and having communication channels in place to ensure medications can be available as needed. Service providers ensure that a paediatrician can be contacted at all times by primary or community care staff to discuss emergency admission and care of those babies identified as having a suspected neonatal infection.
Healthcare professionals (for example, midwives, neonatal nurses, neonatologists and paediatricians) ensure that IV antibiotic treatment for suspected neonatal infection is given to neonates as soon as possible and always within 1 hour of the decision to treat. Healthcare professionals from non-inpatient settings such as GPs and health visitors should seek early advice from a paediatrician if infection is suspected and arrangements can be made for emergency admission and administration of antibiotic treatment.
Commissioners ensure that maternity, paediatric and neonatal providers, working with non-inpatient services where appropriate, give IV antibiotic treatment to neonates for suspected neonatal infection as soon as possible and always within 1 hour of the decision to treat.
Neonates (babies up to 28 days corrected gestational age) with suspected neonatal infection receive antibiotics as soon as possible and always within 1 hour of the need being identified. Antibiotic treatment for neonatal infection is given directly into the vein, so this needs to be given in hospital.
Source guidance
Neonatal infection: antibiotics for prevention and treatment. NICE guideline NG195 (2021), recommendations 1.3.9, 1.5.1, 1.8.4 and 1.10.1
Definitions of terms used in this quality statement
Neonates
Babies of up to and including 28 days corrected gestational age. [NICE's guideline on neonatal infection, overview]
Equality and diversity considerations
One of the clinical indicators of early-onset neonatal infection is hypoxia, which can present as central cyanosis (a generalised bluish discoloration of the body and the visible mucous membranes). Other changes to skin colour can also be a symptom of neonatal infection, for example where the baby becomes very pale, blue/grey or dark yellow.
It is important that healthcare professionals are aware that central cyanosis may present differently depending on the baby's skin colour and understand how best to identify changes in skin colour on different skin tones, such as where on the body to look for changes in colour.
There are some resources that healthcare professionals can use to help identify skin colour changes because of infection, such as Skin Deep, developed by Don't Forget The Bubbles, Mind the Gap clinical handbook and web resource, developed by Black & Brown Skin, and Symptom spotting on darker skin tones, developed by Bliss. These resources have not been produced by NICE and are not maintained by NICE. NICE has not made any judgement about the quality and usability of the resources. Other resources may also be available.
It is important that healthcare professionals recognise that some pulse oximetry devices have been reported to overestimate oxygen saturation levels in babies with darker skin, especially if the saturation level is borderline. Adjustments should be made when interpreting the test results to ensure that treatment is provided when appropriate. While the effectiveness of pulse oximeters can vary on darker skin, they are more accurate than a visual assessment alone for identifying low oxygen saturation levels.