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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...

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neonatalinfectionantibioticsforpreventionand
this guideline covers preventing bacterial infecti
it aims to reduce delays in recognising and treati
the guideline uses the terms woman or mother t

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Neonatal infection:
antibiotics for prevention
and treatment

NICE guideline
Published: 20 April 2021
Last updated: 19 March 2024

www.nice.org.uk/guidance/ng195

© NICE 2024. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms-and-
conditions#notice-of-rights).

,Neonatal infection: antibiotics for prevention and treatment (NG195)

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.

© NICE 2024. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms-and- Page 2 of
conditions#notice-of-rights). 81

,Neonatal infection: antibiotics for prevention and treatment (NG195)

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

© NICE 2024. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms-and- Page 3 of
conditions#notice-of-rights). 81

, Neonatal infection: antibiotics for prevention and treatment (NG195)

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

© NICE 2024. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms-and- Page 4 of
conditions#notice-of-rights). 81

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