Risk factors for infection and clinical indicators of possible infection
Recognising risk factors and clinical indicators
14Use table 1 to identify risk factors for early-onset neonatal infection and table 2 to identify clinical indicators of early-onset neonatal infection.
15Use tables 1 and 2 to identify red flags (risk factors and clinical indicators that should prompt a high level of concern regarding early-onset neonatal infection).
Before the birth
16For women in labour identify and assess any risk factors for early-onset neonatal infection (see table 1). Throughout labour monitor for the emergence of new risk factors, such as intrapartum fever higher than 38°C, or the development of chorioamnionitis.
17Manage prelabour rupture of membranes at term according to the recommendations in Intrapartum care (NICE clinical guideline 55).
After the birth
18If there are any risk factors for early-onset neonatal infection (see table 1) or if there are clinical indicators of possible early-onset neonatal infection (see table 2) perform a careful clinical assessment without delay. Review the maternal and neonatal history and carry out a physical examination of the baby including an assessment of the vital signs.
19Use the following framework based on risk factors and clinical indicators, including red flags (see tables 1 and 2), to direct antibiotic management decisions:
  • In babies with any red flags, or with two or more ‘non-red flag’ risk factors or clinical indicators (see tables 1 and 2), perform investigations (see recommendations 32–34) and start antibiotic treatment. Do not delay starting antibiotics pending the test results (see recommendations 40–42).
  • In babies without red flags and only one risk factor or one clinical indicator, using clinical judgement, consider:
    • whether it is safe to withhold antibiotics, and
    • whether it is necessary to monitor the baby’s vital signs and clinical condition – if monitoring is required continue it for at least 12 hours (at 0, 1 and 2 hours and then 2-hourly for 10 hours).
20In babies being monitored for possible infection:
  • if clinical concern increases, consider performing investigations (see recommendations 32–34) and starting antibiotic treatment (see recommendations 40–42)
  • if no further concerns arise during the period of observation reassure the family and, if the baby is to be discharged, give advice to the parents and carers (see recommendation 8).
21If a baby needs antibiotic treatment it should be given as soon as possible and always within 1 hour of the decision to treat.
22Manage suspected bacterial meningitis according to the recommendations in Bacterial meningitis and meningococcal septicaemia (NICE clinical guideline 102) unless the baby is already receiving care in a neonatal unit.
23Manage suspected urinary tract infection according to the recommendations in Urinary tract infection in children (NICE clinical guideline 54).
24Continue routine postnatal care (see Postnatal care, NICE clinical guideline 37) for babies without risk factors (see table 1) or clinical indicators of possible infection (see table 2).
25If maternal colonisation with group B streptococcus is first identified after the birth but within the first 72 hours of life, ask the person directly involved in the baby’s care (for example, a parent, carer or healthcare professional) whether they have any concerns, identify any other risk factors present and look for clinical indicators of infection. Use this assessment to decide on clinical management (see recommendation 19).

From: 5, Risk factors for infection and clinical indicators of possible infection

Cover of Antibiotics for Early-Onset Neonatal Infection
Antibiotics for Early-Onset Neonatal Infection: Antibiotics for the Prevention and Treatment of Early-Onset Neonatal Infection.
NICE Clinical Guidelines, No. 149.
National Collaborating Centre for Women's and Children's Health (UK).
London: RCOG Press; 2012 Aug.
Copyright © 2012, National Collaborating Centre for Women’s and Children’s Health.

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