Published in April 2021, the updated National Institute for Health and Care Excellence (NICE) guideline focuses on preventing bacterial infection in healthy babies and caring for babies with a suspected or confirmed bacterial infection where the babies are up to and including 28 days corrected gestational age.
Preventing early-onset group B Strep infections and treating both early-onset and late-onset group B Strep infections are key parts of this guideline, which includes new guidance on information provided to families. (NB screening and testing for GBS was outside of the guideline’s scope).
The new guideline makes a number of recommendations:
Antibiotics intravenously in labour should be offered in a timely manner to women whose babies are at higher risk of early-onset GBS infection (including all pregnant women from whom GBS is found during their current or previous pregnancy).
Updated recommendations about which antibiotics should be used in labour, particularly if the pregnant woman is suspected of having chorioamnionitis
A new recommendation that women with prolonged rupture of membranes at 34-37 weeks’ gestation and who have had GBS detected during the current pregnancy should be offered immediate birth (by induction of labour or by caesarean birth)
A updated framework based on risk factors and clinical indicators to identify and treat babies with an increased likelihood of having an early-onset neonatal infection.
A statement that the Kaiser Permanente neonatal sepsis calculator can be used as an alternative to the risk factor/clinical indicators framework for babies born after 34+0 weeks of pregnancy who are in a neonatal unit, transitional care or postnatal ward, but only if part of a prospective audit.
Babies with suspected early-onset neonatal infection should receive antibiotics as quickly as possible (within 1 hour of the decision to treat).
For the first time, guidance is issued relating to late-onset infection:
Risk factors and clinical indicators:
Risk factors for and clinical indicators of possible late-onset neonatal infection are including, with advice for clinicians when assessing or reviewing a baby to check for these, bearing in mind other issues, including prematurity, are associated with greater risk of late-onset neonatal infection.
There is a recommendation to about infection in the other babies when one baby from a multiple birth has infection.
Another recommendation is to seek early advice from a paediatrician when late-onset infection is suspected in non-inpatient settings.
There is guidance both on what actions to take before treating a baby for late-onset infection, as well as which antibiotics to use, for how long and what tests to take before and during treatment.
A helpful framework sets out what decisions are needed at which timepoints to determine whether to continue or stop antibiotic treatment.
Babies with suspected late-onset neonatal infection should receive antibiotics as quickly as possible (within 1 hour of the decision to treat).
More detailed guidance is given about having ongoing discussions with the parents, providing information, explaining options and care, and potential long-term effects of the baby’s illness and likely patterns of recovery.