ipsSe s mnteag neildgu rof setnaNo

Document Control
Title
Sepsis Management Guidelines (early and late onset) for Neonates

Author ƵƚŚŽƌ͛ƐũŽďƚŝƚůĞ
Lead rseuN talNeon and atricedP esvicSr
Directorate Department
calMedi dan atricedP eoatlNn
Date
Version Status Comment / Changes / Approval
Issued
0.1 ovN 15 Draft Inital onversi orf tionasulc
0.2 May 16 Draft edRvis wingofl tsmenco mfro serholdtak
1.0 May 16 Fialn rovpedA yb catriPed ecialtySp amTe 27/5/16.
1.1 gAu 16 atedUp oMrin sionevr owinglf mentsoc rof m stoiglbmcr
1.2 tSep 16 Fialn rovpedA yb Drsgu and ticsuerapTh meaT 15/9/16
Main Contact
SCU ,velL 2 ,welyLad tUni
orthN Devon Dictsri Hotalspi
hRaleig kPar ,Bae,taplsrn EX31 4B J
Lead Director
ednlapU Care
Superseded Documents
None
Issue Date Review Date Review Cycle
merbtSp 20 16 tSep merb 20 19 Thre years
Consulted with the following stakeholders: (list all)
 Morgistbcl
 tPaedric histarmPc
 Pa tedricans
 Nteoaln rseNu
 Mivesdw
Approval and Review Process
 tPaedric pecialtSy mTea
Local Archive Reference
G:/tricaPed /cesoruR esoatnN
Local Path
G:/tricaPed /cesoruR es/oatnN aleotnN eslindug
Filename
siSep elindgu orf esoatnN
WŽůŝĐLJĐĂƚĞŐŽƌŝĞƐĨŽƌdƌƵƐƚ͛ƐŝŶƚĞƌŶĂůǁĞďƐŝƚĞ dĂŐƐĨŽƌdƌƵƐƚ͛ƐŝŶƚĞƌŶĂůǁĞďƐŝƚĞ;ŽďͿ
(Bob) Infect,ion CoS,N GBS, opugr B cus,otrep
oygilbMcr /Myiterna /rvicesS oatlneN iotcb,An its,gnem a,cemitsp ogtisnecr
tis,ocenrl NEC, miocns al, ,cintameg
incleypzb

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CONTENTS
Document Control........................................................................................................................ 1
2. Purpose ................................................................................................................................ 3
3. Definitions............................................................................................................................ 3
4. Responsibilities .................................................................................................................... 3
5. Contacting the Infection Prevention and Control Team .......................................................... 4
6. Sepsis Management Guidelines (early and late onset) for Neonates ....................................... 4
Introduction ................................................................................................................................ 4
7. Before delivery - Intrapartum antibiotics. .............................................................................. 5
8. Care setting .......................................................................................................................... 5
9. Investigations when sepsis is suspected (before starting antibiotics) ...................................... 5
10. Early onset sepsis ................................................................................................................. 7
11. Late Onset Sepsis .................................................................................................................. 9
12. Fungal sepsis ...................................................................................................................... 10
13. Differential diagnosis .......................................................................................................... 11
14. Parental communication and information ........................................................................... 11
15. Monitoring Compliance with and the Effectiveness of the Guideline .................................... 12
s/ardStn eyK ecmanrfoP Inrsicatod ................................
................................
.......................
12
cesPro for Imnoetaimlp and togMrin Coceanmlip dan Efsvenctif ..............................
12
16. Associated Documentation ................................................................................................. 13
17. References ......................................................................................................................... 13
Appendix 1 ʹ Risk factors and clinical Indicators for early-onset neonatal infection ..................... 16
Appendix 2 ʹ Treatment for early onset Sepsis following assessment of risk factors .................... 18
Appendix 3 ʹ Treatment for late onset Hospital Acquired Sepsis ................................................. 19
Appendix 4 ʹ Duration of Antibiotic Treatment ........................................................................... 20
Appendix 5 ʹ Does this baby need antibiotics?............................................................................ 21

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2. Purpose
2.1. The pouser of hist menduotc is to dileta het escpro for necvid asedb best
peracti for het mentag of dpectsu nda rovenp nateol sepi (early
and atel eto)ns

2.2. The pyolic pliesa to het nateol dan tbricseo ultim -dnaryiplsc eamst

3. Definitions
3.1. CoNS - Coagulse -negativ icohylpsta

3.2. CRP - C-reactiv tpeinro

3.3. Early tonse - Babies 72 uhrso old and uernd

3.4. GBS – Group B alcoptsre nfectio

3.5. Late tnseo - Babies over 72 uhrso dol

3.6. N oscmial - Hospital -aedquirc onectif

3.7. NEC – nNgecrotis isornltce

3.8. nNewbor - Babies (besabi erndu 72 hours old)

3.9. NEWS - nNewbor Early ngariW Score

3.10. MRO - Rupret of meb ranes

3.11. INR – Intalerio alisednorm ratio

3.12. SCU – Special Care Unit

4. Responsibilities
4.1. Th e Intionfec ontPirev and Cotronl Cotmie is nresibplo orf :

 Enngsuri hat het pyolic si oapvedr teraf reviw and prio ot huinbgpls
 ntMgori plianeocm ithw het pyolic
4.2. The Intionfec ontPirev and Cotronl Team are spleonrib for:

 P orvide tpsuor ni the ntmpiolea fo this nueidlg nda any

pemsrobl hitw ecianompl
4.3. Th e Cotnasul iancsterdP dan dWar sMrange are nespiblor r:fo

 The tneampiol of t his delingu

 Enngsuri hat het neliudg is eradh o.t

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4.4. The Clnalic afSt are bpleonrsi for:

Foinlogw the anegucid nda ngrtepio any msbplero ithw pliane.ocm

5. Contacting the Infection Prevention and Control Team

5.1. The Intionfec onvetiPr dna Cotrn ol amTe can be tacedno :

 Inuhrso no 01271 322680 (ext 2680 rntalei at Nhort Devon Ditrics

Hospital), via pble 011 ,or
 O ut fo hrsou by ngtiaco het on -cal dalicMe trobiclMgs via thNor
Devon Ditrics Hopitals ithdcbw.oars
 Consutla biolMrc tgis epbl 193. Via oithardcbsw erfta hours

6. Sepsis Management Guidelines (early and late onset) for

Neonates

Introduction

6.1. Nteoaln nfectio is a tgnifacs eaucs fo ityralmo and ditrbymo ni

newbor bies.a alnNteo sepi tusnoca orf 10% of al onae tal toy.ralim
Nteoaln nfectio is senptr in 8 fo eryv 1000 veil thbsir nda 71 of evry
1000 toalne ds.miona Prtomp tbicnoa menatr anc save lives.

6.2. Imalomugicn ty,naive pxosure orsfact nda tayumri fo osth fendsc

rend nateos very epsctibul ot tniof.ec heT risk fo psie ni teoaln
unit misonad is iedfmagn by torsfac ednkli to urematipy nda toalne
nisvet are.c teoalnN sepi enfto opdsevl pidlyar hitw hig itoyralm risk
in het necabs fo ecifsp eratphy, ndema ngi yrlea empircal tibanco
tphyera nhew psie is udsp.ect

6.3. The term sepi atpesorinc embia,ctr monupia,e nmegits, ynarui

trac, nbeo nda tjoin tcion.ef Comon ngtesipr ureatsf do tno lybreia
locaise het tesi of onf,ecti nda any fo esth may oc -exist.

6.4. Early dan tela tonse psie are dnefi as nptreis g efobr nda erfta the rstfi
72 ouhrs of thb.ir hisT ionvsd flectsr ntdcis tiolaegs, rntspea of anorg
nitvolem and es.utomc

The enralg tyalif tera of rlyea -on ets sepi esvari etnwb 15 dan 04 %
ndgepi no the seri trepdo.
The enralg tyalif tera of tela -otnse psie is pimatelyrox 5%, htugoal it
is zedorgnci hat hotse ntfsai how ehav a ngedoprl pithalos oucrse ehav a
higer ntpialeo rfo bimor tydi and ty.ralimo

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7. Before delivery - Intrapartum antibiotics.

 Se ustTr deslingu rof Intiondasc orf otsicbnA During ouLabr lucding
nPrevtio fo Grupo B alcorepSt Inectionf.

 If ernmatl ntolicsa ithw upgro B ucsoptre is first ntide dfie teraf eth
hbirt utb nithw the rstfi 72 uhrso fo fe,li inertasc if hert are any rnseco dan
if hert ear any rthoe skri factors or linac atconrsdi of eposibl onfecti (se
apndixe 1 ). eUs hist esmnta to d treci temn.ag

8. Care setting
8.1. Al ornewb biesa hitw risk factors or uionspc of psie oushld eb redf
to a dlemi adegr tricandpe or tenquival medlyiat dan darec for ni an
are terminpg losec servatoinb.

8.2. Inovestiga ilw etak lacep u sualy in eth talneo t.niu Dungri hist time
the staff will assess the infant and taking into account the baby’s clinical
oncdit dan edns . eh T bya ilw theri eb mitad dte to SCU or to Baets
Toranlsit Care (BABTC). Se rustT deslingu rof Tra ntalios Care.

8.3. Th e b a y has a set fo dalicme tneso datenrg dna /his her etdails are redtn
ont Badger e.tabds

8.4. If het bay is to eb tdemia to BABTC a ursing arec npla for nfectio ilw be
placed onti the tneso dna a tse of NEWS obs ionrvatse ilw be tedplomc
brefo the bya is erdftans to het post –
taln ardw.

8.5. Al travenouis stbicnoa ilw be ednistarm on SCU by het talneo

nurse.

9. Investigations when sepsis is suspected (before starting

antibiotics)
 Blod tes

o Blod eturcl –aysAlw erfpom a dblo eturcl efbor het first edos fo
baniots.c nimuM omecdnr olumev 0.5ml.

o Ful lodb notuc.

Dinterfial hitwe elc unotc (Nalorm WBC 10 -30,000 x 10 9/L) dan agetrcnp
left ftshi (iretuma /ropntheuils talo louptnhrei otu)nc .
Note
If >20% this is moderately predictive of sepsis.
A low WCC especially with neutropenia is also suspicious of sepsis.

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o C-reactiv tpeinro (CRP) onecatir (this is neth tpedar 24 uhrso refta

omecnig tibanco heratpy)
CRP > 8 aym be asume d as d.raise
Note
Serial CRP s may be useful. An isolated CRP or one done within 18 hours of
onset may be misleading if negative

o Blod gas

o Blod rsuga

 Lumbar urentpc (consider)

Nteoaln nmegits ucrso in 0.25 -1.0 per 1000 ivel thbs.ir reTh dhouls be a
low dtesholr for rumbal rentpcu ni al aticompsy toesna hitw tcedusp
sepi. Hoevr,w rumbal rentpcu is tno dneatic in ticomasyp ornsewb
uergonid natevluio rfo risk orsfact n.lyo

Permfo a barlum urentpc befor tingars otibna sc if it is tuhgo esaf ot do it

and:

o Ther is a nstgro linac suionpc of nfectio

o Ther are linac mstopy or sign tingsue tenismg

If a bay di tno have a umbarl urentpc at tniopreas dan is eivnrcg

baniotsc rnsideoc erfominpg a barlum eurntpc if it is esaf ot do so dan if eth
bay:

o Has a C -reactiv notpeir onecatir fo 10mg/treli or re,mo ro

o Has a tivepos dblo uretcl ro

o Does not pdonres to bniotca ntmera actosrilyf

Beyond the tfirs 84 hs,our lrumba turenpc sho dul eb erfomdp in al vioupslyre
heaylt teosna thiw spectud sepi dan no tionda.cr Indlivua
juendtgm by an nedxpcri nateol iantedrcp is toperia for dpectsu
late tonse psie in atoesn ngeivrc nsivet heratpy. baLum r entpcur
dshoul eb dref in oesnat derga as to nestuabl to ateolr het
puedro,c or erhw reth is na btsoluea ondat.icr
Note tbicnoA phyerat dshoul otn be delay rfo dnpela umbarl re.untpc
tAdliona tdhsmeo fo atnhpoge di osiagn (PCR ro hoert tigena ontecdi
metodh) doulsh be seduic ithw Clincal iolMrgstbc ni al asec fo nobrmal
CSF elc otucn nda veating Gram -sain.t

 Chest X -Ray

This is a nuetroi entpomc of toalne pticse rensc, dan is tnodryam ni al

i ntfsa hitw tesporyia distre, oapen or nutiogc enygox nutreimq.

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Note nA bindalom x -rya is tedinac in het enpcrs fo bmindalo sign

sugetiv of tniecro s ing tisenrolc (NEC).

 Urine eturcl

Do not nuelytroi erfomp eurin pymicros or c urelt as tpar fo eth

tinovesga rfo early seton ateoln nfectio
Urine eturcl is tno redqui ni dpectsu early setno psi.e Beyond the rstfi
48 ouhrs, neuri dhouls eb deroncsi in al upslyrevio thyeal esnato thiw
sudpect psi.e henW nec esary, nueri for uretcl dhouls be doainbet iav
supra -pbicu nratiosp inlogwf utnrasodl matfionrc fo rineu in er.dbla

 Eye absw rfo dpectsu inofect

In biesa hitw a unrtple ey hargeiscd etak sabw utrgenly for gylomicrb

using etodhsm t ath nac tdec diahclmy nda uncs.og (se ustTr Eye
Care for toesnNa Gulines)d . artS stemyic atmenr for bleposi
gonalc onfecti lehiw aitwng het absw ults.re

 alUmbic absw for ectudsp nfectio

In biesa hitw sign of mbalicu i onfsecti mfpore a odbl turec,l etak a

absw for microspy nda ureclt nda tsar tbicnoa neatmr (se denixpa
4). If biolmcrgy ltsreu od otn show a gram -negativ ectniof opst eth
nge.tamic
Note
inSk absw rfo ypmicros or turecl are n to reduqi ni the necabs fo
linac sign fo alisedoc inof.ect

10. Early onset sepsis

10.1. Organisms responsible for early onset sepsis
The tndapomire ensoatghp omec omfr the rnalemt nitalge actr nda :are

 Group B ucsoepStr (GBS)

 E oli,c ertho trepS ,ico

 Haemoupshil uzneaf,li

 Listera ogens.ytcm

10.2. Assessment of risk factors and clinical indicators to guide

decision to treat.
nNewbor biesa dhouls eivrc a hpenrsivomc linac tasemn for het srik
or aticnorsd fo rlyea seton toalne onf.ecti This desinluc ngdteify any risk

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factors or linac orsdaticn for early tonse atlneo nsectiof and rminefpgo a
palichys natexmio fo het bay (with tasemn fo alvit sign)

eUs the blesta 1 nda 2 ni a pdenix 1 to irectd niotbac ntagem ecisond

based on risk orsfact nda linac ors.daticn

 If a baby has no red flags and only one risk factor or one clinical indicator use
linac ndtgemju and o:nsiderc

o afSety of nhitgoldw ibnots.ac

o Necs sity of monitoring by baby’s vital signs and clinical condition. If
monritg is edquri eus ornNewb Early gniWar Score rthca for at least 12
hours. (at 0, 1 and 2 rsuho and hent 2 uhrlyo for 10 ouhrs) . This is medrfpo
by midvesw fi the bya si arc ed for on het talnpos ardw by the thmoer.

If linac nerco es,inrac eroncsid perfoming necsary ontsigave

and tingars tbicnoa neatmr

If no huertf nsoerc seari rindgu eth deriop fo bnservatoi easur het

family. If eth bya is to eb edh,argisc egiv balver and enritw eadvic to eth
ptaresn nda aresc (se ptoin 14 )

 /Ĩ Ă ďĂďLJ ŚĂƐ ĂŶLJ ƌĞĚ ĨůĂŐƐ Žƌ ƚǁŽ Žƌ ŵŽƌĞ ͚ŶŽŶ-ƌĞĚ͛ ƌŝƐŬ ĨĂĐƚŽƌƐ Žƌ ĐůŝŶŝĐĂů
indicators :

o ePrmfo tniovesga (se e 9 ) prio to nicogme otsicban

o tSar otsicban hintw neo hour fo ecisond to eatr (do otn aitw for tes
result )

Note –do not routinely give antibiotic treatment to babies without risk factors or
clinical indicators for infection or laboratory evidence of possible infection.

10.3. Perform clinical investigations (see point 9)

morPef osnatiegv in larticup odbl erltuc reofb gterinsmad oticsanb

10.4. Antibiotic Management for early onset sepsis (see appendix 2)

 The tsfir odse of soticban should eb istermdna withou yelad - withn oen orhu of
the ondecis ot emnco ytherap (wotuih gwaitn rfo result).

 Time of deci sion ot trea oldush be edocumnt and onrsaticve and noifrmat vgien
to ents.par

 Use incleypzb with cinetamg lesnu oicalgmrb ecvanilsur atd ealrv loca
lacterib esitancr sernatp ind cating a entfrdi iotc.ban

Fowol Trus t eslindgu orf entamicg e.su

 If hert is oicalgbmr evncid of Gram -nvetiga erialctb ,sepi da oanther

iotcban ot eth enzb l nliceyp dan entamicg imenrg tha is veacti tsaing Gram -

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egativn etriacb (for mlepxa me)axifotc . If Grma –

vegatin onectif is edmofirnc
stop .incleypbz

 The seu of oadbr -strumpec siotcanb –in larpticu inxclmoa dan metaxifoc ni
atiomnbc ash enb wnsho ot otempr ntiosalc and ksotbreau of mltiu -rtsiane
ismanorg such as mgra -natige ve iclab (Issac 2000).

hgtouAl csiotanb ear gesavinfl in epsi, they also aveh a mentaldri ctef no
oisatncl of eth estin with a malnor icalgobmr flora. It is olesibp sith is an
tanoimpr part of malnor ment,opvld and ath d tiopnsru in yearl elif may veah
tcanifsg later ces.nquo This yoclip siecongr erht is a ontesi entwb early
mentra for seip (whic is )lenficab dan arysecnu mentar (whic is l)mfuhar .
In ,genral iesba with 'red ' flag sign and s somtpy edn geatinr thwi s.ticoban
mentagM si mchu les clear in iesba owh yoln veha kris ,torsfac or les ficspe
icatodrsn of o.nctife Idy,ale isth yertaincu oldush be redsha with eth ts.arenp

10.5. Duration of Antibiotic Treatment (see appendix 4)

11. Late Onset Sepsis

Late-onset neonatal sepsis is edfin as an tionfec gincuro after the tfirs 72 orsuh or 3 -7 ysda of
fe.li

Hotalspi -aireducq tela -oetsn tionecf scuro in toabu 20% of yver wlo irthb thweig ts.fani Gram -
eopsitv simanorg ate,inomprd laseougc -netivga cioyltaphs (CoS)N gtinouac for
yatelroximp fhal of al se.ca

11.1. Organisms in late onset infection

 Grma -pesitvo simanorg

o Colaseug -ntivega ociylhstap

o oycuslhStap saure

o Ente cior

o cusoStrep sp

 Grma -nvegati msioanrg

o E coli

o aKlebsi ecisp

o oasnmPeud sp

11.2. Assess Risk factors and clinical indicators for late onset infection
(see appendix 3)
The orceus of onectif in atel osetn seip is theri mialcosn (htalospi -a)iredcqu or
ymitconu -aireducq and esoatn ylsua tpresn htwi mia,setcp oianeump or

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its.gmne The tera of onectif is lyraeng yelvrsin tedrla ot thbir twheig dan
oalnestig eag .

Factors ath thmig eascrin the kris of yitmonuc -aireducq late tosen tionfec edcluni :
 opr e,inygh
 opr cord care,
 obtle -f,gined and
 relactp feds (that is any food except mother's milk provided to a newborn before
initiating breastfeeding ).

11.3. Perform Clinical investigations (see point 9)

Clicaln atiosgnve as rof yearl etosn tbu o erth set yma eduincl :
 Blod ltcu reu yma be netak hgrotu ralcent elin (ieadtsn or in itonda to a eralhpi
e)nli
 eLin s,tip trachelodn tub e stip etc sent orf yposcmir
 enUri yb icburaps teraspi or ther.ca

11.4. Antibiotic Management for late onset sepsis (see appendix 3)

11.5. Duration of treatment (see appendix 4)

12. Fungal sepsis

onsmTrai of Caaidn aym eb ticalver (fmor alernmt alinvg tio)nfec tbu it si yalus
late osetn and .mialocns
Caaidn miatcesp secari a 25 -50% omrt tyali sk.ri Feresatu are yeralgn
leabishugtnd from eosth of albcteri sepi. Fualgn sepi oldush be edrosinc in
lesucptib esoatn who aveh edlfai ot spondre ot iotcs.bna
Ther is tedlim encvid ot sup topr the use of oral dna toicalp algntifu yolaxishpr in
mretp esoatn dan at presnt sthi is otn tarp fo etinuro eractip in eth UK.
The osariuv tiosnaepr of Caaidn tiosnfec in the onewbr can be edsartp into the
wingfol esgoricat [ 6]:
 osuectanM siadcn
 micSyste siadcn lyicapt eud ot edozcali sonectif tah oresgp ot
edatismn tiosnfec and anorgmltiu enmolvi t
12.1. Organism
Caaidn speci (C ,sicanlb C siolarp and C s)alitrocp ,

12.2. Risk factors

Se risk orsfact orf tela etosn seip
erOth r kis torsfac i n nitoad :
 Broad mctruspe ticoban seu
 Evencid of ealtrch Caadin onisatcl

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erOth c icaln orsicatnd in itonda :

 Skin and osumc esmranb - sh,tru yp an rash o r other ares
 Eyes - Caaidn mitshalopden
 Heart - iacrd mrs,u e,tchiap skin es,abc ymegalptoh and
ym.egalnosp
 eynKid - arinu y trac ctionef
12.3. Investigations
In itonad ot topin 9
 Swab (my)scopir orf kins sleion
 O oicalmgthp tio,namex
 Ecmoragihcd
 R enal donultras
12.4. Management for candida systemic infection (see appendix 3)

12.5. Management for candida skin and mucosa infections

 oleMicazn elg ( reca dolush be entak thwi tionrasmd ot oidva gkinoch
 ystainN ensioup or amrec
 Coersidn gtreain yba htbo olyra and lyoicapt
 Coersidn gtreain otherm if she is eastbr ginedf

13. Differential diagnosis

ocliMetab os,nitcd taleniogc heart e,disa dan atlerinp miaevr (eyspecial eshrp
lexsimp and )seviruotn can entprs thwi icaln esaturf leabishugtnd mofr oatlne
sepi.

14. Parental communication and information

 Kep the enarp ts/carers fully informed of risk factors, clinical concerns, baby’s condition,
otispn for ent,mag yan otacn setaild of oprtsu os,niatrg woh ot drespon
to ernsco dan any ognl term ectsf (se I
N CE ceanidgu ).
 Gani ylfu edmforin tnosec fro m entsarp (wher ole)psib orip to gcinmeo or
gincha any ent.mra
 Wher entmag is ertaincu orf examlp
 Ptsaren or cares of iesab in whom early etosn atlnoe fection ash enb a coern
are enivg ritenw onmatifr toabu oatlne ofectin .n This is edmntocu . reTh are 4
tionfrma seaflt le:abvi

o ‘Infection in Newborns’ Trust parent information leaflet

t:/ph /ww.altveohnrd .h s.hn k/u tio/narmfep /etricsob tifecn
swbo.rn_ei fdp

o GBS tparen ationrmf fleta s le.abvi /tp:h /gs.b .org k/u eaflts -
s/adownl etsafl -ped/trin #84 o n sgb s..org ku ebsitw

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ipsSe s mnteag neildgu rof setnaNo

o Congratulations on your baby’s safe arrival (2015/04) –an yctoudrin

leaft otuab opurg B epStr aimed at smielfa erwh a ealthy yab has be en
obrn and GBS sha enb dnouf on a efacsur wabs grindu or eraft y.verlid

o Understanding your baby’s group B Strep infection (2015/05) –an

oryctudin teafl a tobu proug B Strep edaim at entspar of a yab
onsediag thwi GBS o.nctife

 When the yab is edargisch mfro the talospih (or in the atedim ostnalp eriopd in
the case of iesab obrn ta e)ohm , mforin eth tsnarep dan cares dan the y' ab s GP,
yvlerba dan in ,gtinwr if eth yab is erdcosin ot eb at edcrasin risk of noectif

15. Monitoring Compliance with and the Effectiveness of the

Guideline
Standards/ Key Performance Indicators
Key nefcoPrma norsdatic on hicw to base earc in eth pecialS Care tUni are:

 eNic teoalnN ualityQ ands.trS

o NICE litqyua dtarns S7[Q 5] lnNateo Innfectio
 NHS tTiolk orf High lityQua toalnNe ervicsS
 Nnatlio nNateol ditAu Progame
 NHS dnStar Cotnrac orf toalnNe Crtalic Care

Process for Implementation and Monitoring Compliance and

Effectiveness
 Stfa are edfoinrm of wne ngue.idl herT is na exponctai hat fsta era
bresploni to epk atedup on any temnsiprov ot eractip nda rdeliv arec
ordac.ingly
 Data is edolct by use of Bardge atd base dan anc be duse to tnerag topu for
linac dan tpionaler enhibcmarg.k
 Nerumb fo alntrec neli aysd and tedrla nfectio are dtorenim via alisedSpc
CQUIN nNateol Crlaitc Care Daoshardb dan eth toalnNe tudiA rotjec.P tsReul
are redompca acros onNae tal tsUni by het hutSo tWes teoalnN .kotrwNe
 Inidtcens are nreditmo by het nateol necagovr eamt nda talneo .etorknw
Inidtcens are tpedor yb the Datix stemy dan ohutS tWes nNateol orkwtNe
indtce ngrtepio s.eocpr
 N on -anehcrd is edviwr nda nactio anspl edma if du.reiq eThr is a eviwr of
drelat ntidcse nda mptslainoc no a lyekw isba by het Intionfec Cooltnr Teams,
plus ntiopreas fo eths asec herw tepriao ni the tmohnly tenidc tpore ta
IPCC. Diusionc nda ewsrvi o ucr at Ditecora nmegs,ti Gonaecvr etinmgs
and ardW tinmegs. rnieagL and nactio plans ear adsce at hest tinegsm nda
impntroves dn.temipl Key ngsdfi dan arnileg ntpsoi ilw be emdinats
to telvanr f.ast

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 Asemnt of ndha enihyg e necpliaom as tedlis in het tmohnly dboashr ot IPCC

dptresn by het Inonfecti Control ms.Tea

16. Associated Documentation

16.1. NDHT Eye arec slinuedg for toesna

16.2. ND HT Inondatic for biotsAnc ndguri brouLa udinlgc eniotPrv of Grupo B

Stalcorep In onfecti Gunesidl

16.3. NDHT Inionfect ontPirev nda Coronlt nalioertOp yolicP

16.4. NDHT ernMatl Sepsi urindg napy,creg broula and eth ostp -luabro odperi
(Inlucding rnmatle r,fev tisonramhc dan entmisdro finolgw arige)msc

16.5. NDHT nNateol dan Chil drens ardw ntalpioer OPS

16.6. NDHT atPedric nda natole Getamicn 5mg/gk Guinedl

16.7. NDHT hPaotlgy enpcims tepanc yicpol

16.8. NDHT ermPt per -lruabo upret of anmebr

16.9. NDHT neoptuasS upret fo anembr at mter

16.10. Mnatler epsi nda biotanc elinudsg for etricObs ondatsic

16.11. NDHT dtarnS Innfectio Coonltr tionaurecsP ycPoli

16.12. NDHT tTionalrs arec nguesidl

16.13. NICE 2007 Clincal nedligu 7

4 . Fehveris nesil ni hncildre

16.14. NICE 2007 Clincal nedligu 54. ryUina trac tniofec in enhcildr

16.15. NICE 2008 Cli nalic nedligu 70. Inodnutci of rulabo

16.16. NICE 2010 Clincal nedligu 102. Baialterc itnsmeg dan alngoceim
septami.c

16.17. NICE 2011 Clincal nedligu 132. Caeansr nectios

17. References
 Austin NC, Darlow B. ophPractiyl oral lnfgauti agents ot prev tn micesty candi
inofect in tperm ntfs.ai Coranech Daasetb tSys Rev 2003; 1. Butery JP. Blod
uescltr in ornsewb dan d:renhcil npgtoims na evryda tes. Arch. Dis. Child.
2002; 87: F25 –F28

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ipsSe s mnteag neildgu rof setnaNo

 Car R, dMio N, Dore et l.a G -CSF or GM -CSF orf t eatinrg or ngtpirev nateol
inofsect (Conechra iew)Rv . The Conechra Dabaset fo ematicSys sweiRv 2003,
Issue 3
 E. de Man P, nhoevV B, bruVegh H te al. An tibcnoa yolicp to evntpr
emrgnc of tanresi acil.b tLanec 2000; 355: 973 -978
 GBS S (Group B ptreS puortS), (2007). [on -l]ine nevgtPri GBS niofect in newbor
baies. .w bgs.org.uk (aesdc 3/6/08).
 Health P, Balfour G, and Weisner A, Efstratiou A, Lamagni T, Tighe H, O’Connell L,
Caferky M, drlaneV N, oNlic A nda MC c yneart A, (2004). Grpou B paltcores
disea ni UK and Irish Intfsan les nt9 ha 0 days of age. netcLa 24 vol 363 (9405) :292
 Interim Best Preacti odnmeatsiRc for het orenvtPi of toalnNe Grp B repSt
Inonfecti ni U K. eunJ 2001. PHLS Grupo B ucsopStre inWogrk Grupo
 Isacs D. nRatiog oticbna use in het lnateo unit. Arch Dis Chdil 2000; 82: F1 -F2
 zicKarlow M, Bueschr E, Suark A. Futnalmi ateoln psie in a nateol nsivet
arec itu,n 1988 -1997, dan het mpacti of dingavo empirc inomycva aphy.ert
t,Pericsda 2000; 106: 1387 -1390.
 smithLock te al, (2000) Mnatler and teoaln nofecti rates with hret nfdteri
polscrt orf ntpiorev of Grp B trepS ase.di mA J teObs Gynecol. 1999; 80: 416 -
422
 Lu kc S, et al, (2003) Esmatedi early tonse upgro B altscorep teoaln disea.
Lanetc 2003;361:p 1953 -4
 May M, A J Daey,l S Doathn et al. Early tonse nateol nmegits in alitrAus dan
New ndZea,l 1992 –2002. Arch. Dis. Child. 2005; 90: F324 - F327
 M Gc uire W, Clewrih L, Foliew P. Inonfecti ni the tperm tf.ani BMJ 2004; 329:
1277-1280
 MGc uire W, Clewrih L, Austin N. phPractioyl travenousi nfgaluti ntsage to
ptrevn toyralim nda otrbyidm ni very owl thbir eightw ts.anif Coechran Databse
Sys t Rev 2003; 1
 Nteoaln Resourc ecSrvi (2013) [on -le]in atlnNeo psiSe
hpts://w.w une.tihlardoc om/c /mconte derI Povi I/UHC/en -
US/Aset/FtrSicPoavde iles/tdaFerSPicov dfP/iles 2 Tols% 0an2 d% 0Rources/ ol P
2 ies%c 0an2 d% 0Ps/orlct 2 Mal%iced 0Poies/lc Cl2 nal%ic 0Gu/elinds natol_ResN
ource_SvisCGnal_ic si.nepNatou_dlS pdf (aesdc 25/10/15)
 nNewbor esSrvic Cllnaic Guelind (2008) otsicbAn orf nateol sepi
/hpt: /w.w adhb.ovtg.z/n /ewborn Gudes/lin In/onfecti tsFibAnco teoalSrnpN
si.htm (aesdc 19/10/15)
 NICE 2006 Clincal nedligu 37. Post taln are.c
 NICE 2007 Clincal dgui neli 55. Intmrapu arec
 NICE 2008 Clincal nedligu 62. tenalA arec
 NICE 2012 Clincal nedligu 149. tsbicnoA for rlyea – tonse nateol tionfec
 eNic (2013) [0n -lne]i CK.S Candia oral des.lingu :/thp /cs.k ne.ic org.uk/danic -
oral#i!ensc (aesdc 25/10/15)
 NICE 2014 QS75 alteonN Inectionf
 Ohlson A, Lacy JB. Invenoturas nbuimolg for ngtpirev onfecti ni rmetp
and/or low thbir -whteig ntfsai (Conechra )iewRv . In: heT Cohranec ry,aLib Issue
2, 2003

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ipsSe s mnteag neildgu rof setnaNo

 Plymohut NICU, Liley J, (2011). Guelinds rfo Group B ucs.opStre

 Ray B, Meanglor J, Haumarki C te al. Is rumbal tpurenc ecsaryn for valuntioe fo
early toalne psi?e hcivesAr of Diesa in Chhodil 2006;91:1033 -1035
 Roen J, hRenc M, ztneKoi C te al. Enheaoltdrc lonisatc thiw Cadnai enscha
risk of icstemy Casidan in very owl thbir eightw es.nato rnJoalu of sedicatPr
1994; 124: 789 -94
 RCOG (2012 ). Gren pTo 36 on[ -l]ine ontPriev of e arly nseto toalne upogr B
altscorep easdi . (aesdc 25/10/15)
 Schrag te al. Grupo B epaltscor disea in eth era of trapnumi iotbanc
.phaxisroyl NEM.J 2000; 342: 15 -20
 Schrag te al. nPrevtio of terinalP Grpou B putcsoreS disea e. edisRv
nguesidl from het CDC. Aug 2002
 Schuat A. Grupo B putcs.oeSr netcLa 1999; 353: 51 -56
 Truo NICU. (2006). Gudelins on het entmag of GBS nfectio (or iskr of GBS
inof)ect Inpuartm nda nNateol nts.iePa
 Tzybulewic ,A Cleg S, Fonfé G te al. termP econium nistga of het niotamc
f:luid tedasoci ngsdfi and risk fo ersadv alicn tome.cu hivesArc fo Disea ni
Childoh,2004;89:F328
 WHO (2014) CC newbor tonaleN epsiS [on -le]in
hpts://w.w ogle.o.c /uk ?gs_rdntguoe& ial+w=#qp s
t1 ar= 0 (aesdc 19/10/15
 UCSF 2004 Cadiasn ni eth ewbornN Gu.nesdli [on -l]ine
hpts://w.w sfuhnbcild.ero org//dfp ls/uman 4_Cdians.dfp (aesdc
25/10/15)

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Appendix 1 ʹ Risk factors and clinical Indicators for early-onset neonatal infection

Use the tables 1 and 2 to direct antibiotic management decisions based on risk factors and
clinical indicator including red flags.

1. If a baby has no red flags and only one risk factor or one clinical indicator eus
linac ndtgemju and o:nsiderc

o afSety of nhitgoldw ibnots.ac (this doulsh eb usedic ithw het snptare

nilugcd the ntpialeo netdrimal tefc fo eus of tsbicnoa e.g. on het
olncisat of het inaltes flora)
o Necessity of monitoring by baby’s vital signs and clinical ntiod con for at eastl
12 ouhrs via E N WS (RCOG 2012 mendsorc 24 hours)

2. If a baby has ĂŶLJ ƌĞĚ ĨůĂŐƐ Žƌ ƚǁŽ Žƌ ŵŽƌĞ ͚ŶŽŶ-ƌĞĚ͛ ƌŝƐŬ ĨĂĐƚŽƌƐ or clinical
indicators :

o ePrmfo tniovesga riop ot enicogm biotsanc

o tSar otsicban hintw neo hour fo ecd ison to eatr

Table 1 RED
RISK FACTORS FLAG
Invasie pgrou B alctopsre tionfec in a srevioup yab
rnalMte pgrou B alctoepsr ol,nisatc riuatecb or tionfec
in eth trencu yacregnp
ourelabP retup of sranebm
rmetP irthb following spontaneous labour (before 37 weeks’
staion)ge
dtecSusp o r edonfirmc retup of esmbran for orem anth 18 oursh
in a rmetp irthb
0
Inmartup fevr igerh anth 38 C, or dtecsup or edonfirmc
sitornhamc
raltenP iotcban trea tenm given to het rothem for edonfirmc or
dtecsup invase rialtebc tionfec (such as ia)emtcsp at yan etim
ringud our,lab or in teh 24 ourh eriodsp befor dan after eth ibrth (not
grefin to muartpin iotcban ylhroaxips)
dtecSusp or oc dfirmen tionfec in raothen yab in teh asec of a
letipum ycanregp

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Table 2 Clinical indicators of possible early-onset neonatal infection

(observations and events in the baby). Including red flags.
Table 2 RED
CLINICAL INDICATORS FLAG
Alterd eb raviouh or seivnrpo
Alterd scleum tone (for lexamp s)ineopfl
Feinged ltiesufcd (for lexamp fed refusal)
Feed e,colranit ingldcu g,itnvom excsiv ricgast sapirte dan
alomindb sionted
sSign of ryspiatoe sitred
irResp oryat sitred gtarins orem anth 4 hours after irthb

Hypoxia (for lepxam tralenc osiyanc or edcur oxnyge rationsu

lev)
eicdnuJa inwth 24 hours of irthb
oeaApn
sSign of taleon yathlopecn
resSizu

dNe for ardioc -ponarlmu y res su onitac

dNe for alicnhem tilaonve in a rep -trme yab
dNe for alicnhem tilaonve in a rmte yba

tnersiP foalet lationurc (ptnersi uonarylmp sionertyph )

0 0
reatupTm alityormnb (lo wer anht 36 C dan erigh anth 38 C)
dlainexpu yb talenvirom orsfact
sSign of shock

dlainexpU esivxc ,ingdleb ia,enocytpbrmh or alormnb

ionagultc (INR rtega anht 2.0)
rialguO ( tnersip eyondb 24 oursh after )irthb
Alterd osecglu sometaih (hiamoglycep or iaemrglycph )a
olicabMet idosac (base itefcd of 10 mol/litre ro reatg
Local sign of ntiofec (e,ye skin, s)ilcumb

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Appendix 2 ʹ Treatment for early onset Sepsis following assessment of risk factors

1. seA gusin kris orsfact dan icaln rsicatond (se ixendpa 1 )

2. Give onmatirf ot stparen and ngai lyfu edormfin osentc orf resduocp dan mentra ,
(iedclun olepsib altmendri tsefc dan yetsaf fo ginohldtw )iotcsanb
3. morPef osnatiegv
4. istermnAd csiotban inthw in oen oruh of decis oni ot eatr
5. For daneguci on ngdosi leasp fer to BNF for Chldreni or udsic hitw
tmicroblgs

 Note - The seu of oadrb -smectpru csiotban –in larticup incloxam dan meotaxicf
Type of Sepsis Empirical therapy
Early onset septicaemia Benzypenicillin and Gentamicin
gStarin edos incleP 25m/g kg yver 12 orsuh and
Gemicnta 5 mg /kg eryv 36 orsuh
2nd Line antibiotics
ePlas erag sthi after sionudc thwi tanosulc oistgrlbmc

 oicalgbMr evncid of Gram -nvegati erialctb sepi, da

me.taxicfo

 If Grma –
etivgan ntiofec is medcofirn opst .incleypbz

Neonatal meningitis
 Pathogen unknown

inlAmoxc and Ceeximotaf

 Gram negative

Cemeaxifot olyn

 Gram positive

inlAmoxc and Ceeximotaf dan kse oistglmcrb vicead

 Group B streptococcus positive

Beincleypz 50m/g kg 12 yhorlu orf at least 14 s,day wit h

Gemicnta 5m/g kg 36 rlyouh
Listeria inlAmoxc and micngeta
in oncatimb –ash neb shown ot otemrp isatonlc dan eaksotbru of mltiu -
resitan msianorg such as mgra -nvegati libac (Iscsa 2000).

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Appendix 3 ʹ Treatment for late onset Hospital Acquired Sepsis

1. Assess using risk factors and clinical indicators below (these are not exclusive)

Risk Factors Clinical Indicators

 Hymiaopther or verf (ferom is emor
 L wo irthb thweig omnc in metrp owl thbir thweig ts)anif
 P ymitaure  ,yLargeth orp cry, salrefu to ksuc
o taenp ctusd osu,artei  oPr o,nsierfup deognrlp ylaricp lrefi
o yoarnlmuchpb iadyspl (BPD) time
o secronti gin otislcern (NEC).  Hyoia,npt entsab loatne esrflx
 A mdison in vesitn care itun  Bry/ad iardycht
 M icalehn ontielav  oryatRespi tres,id oeanp dan ginasp
 Ievnasi rescduop rationesp
 Inevasi eonatl y,aperth (eylspecia  Hyop/ miaceyrglph
ginweld senouitrav etrs)hca  ocliMetab ocids.a
 A istramdn oni of ralentp s,idflu dan esu  Gelynera ogkinl elwun
of kocst tiosnlu

2. Give parents information and gain fully informed consent for procedures and
treatment
3. Perform investigations
4. Administer antibiotics within one hour of decision to treat

Suspected or proven sepsis Recommended Antibiotics

Late etosn miaeptcs and icalumb onctief Flcloinuxa and Geinmcta

For Eni,coter pStre aeliscf (sudspect NEC), steriaL or

dA A inxymclo
Group B ucsoepStr
S uionspc fo bicaeron nfectio (e.g. train -ainalobmd dA M oazleidntr
sepi, NEC ).
Coagulse negativ alcohypSt sepi, (e alypecis if
Coersidn V cinmyoa
nitfa uelnw or alntrec neli tniofec itwh line nyigsta in ).
Discuss with microbiologist.

Candias
ericnoAmpht B
M ngites
Chegan to Ceemotaxif
Discuss with microbiologist.

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Appendix 4 ʹ Duration of Antibiotic Treatment

Discuss with microbiologist if there are any queries

Duration of treatment

5 days  Treat orf 5 ysda if sieba ear elw dan onectif was spectdu
olyn tub ercosidn ginopst at 36 shoru and on a yaild asib
er.thaf

At 36 hours  The odlb erltuc is ve,gatin dan

 The italn icaln iconsup of onctife was not ,ognstr and
Consider stopping if  The baby’s clinical condition is reassuring with no clinical
icatodrsn of olesibp ,ionectf and
 The vel and strend of C -rveacti p oteinr onetraic are
ginreasu
Coeutin orf
more than 36 hours  The vel of the tialn alicn cionspu of onctife
Use icaln entmgjud  The baby’s clinical progress and current condition, and
yaild ot erosidnc gtoinps  The vels dan strend of C -rveacti oteinrp o.netraic
gacoinrd ot

7 days Treat orf 7 ys:da

 If iesab ehav esitvop dolb resltuc

 oianPeum
 S miaeptc

More than 7 days Treat orf orem anth 7 :days

 If The yba has tno ylfu erd,cov or

 This is lesabvdi edbas on eht p enathog tifedn (refer to
microbiologist)
 arynUi Tract Inonectif
 itsgnMe
 Casiadn (refer to microbiologist)

Other

5 days Skin osncitd

5-7 days Cotiscvnju

7-10 days Oral aidcn

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Appendix 5 ʹ Does this baby need antibiotics?

Risk Factors SIGNS & SYMPTOMS

RED FLAG NON-RED FLAG NON-RED FLAG RED FLAG
 Maternal IV - GBS in previous - Altered behaviour or - CPR at birth  Respiratory
antibiotics for baby responsiveness - Mechanical ventilation (preterm) distress
invasive - confirmed GBS in - Altered muscle tone - PPHN starting ≥4
bacterial this pregnancy - Feeding difficulties - Temperature abnormality hours after
o o
infection 24 (swab/HVS/urine) - Feed intolerance inc. (<36 or >38 ) birth
- Prelabour ROM - Excessive bleeding (low platelets)
hours either
- Preterm ROM >18
vomiting
or INR >2
 Seizures
side of birth hours - Abnormal HR
- Oligura longer than 24 hours  Mechanical
 Suspected or - Prematurity <37 - Signs of resp distress - Unstable BMs ventilation
confirmed weeks - Hypoxia - Metabolic acidosis (base deficit (term)
infection in - Maternal fever >38o - Jaundice within 24 hours ≥10)  Signs of
twin/triplet OR suspected/ - Apnoea - Local signs of infection shock
confirmed - Neonatal encephalopathy
chorioamnionitis

1 NON-RED FLAG 1 NON-RED FLAG

≥ 1 RED FLAG
≥ 1 RED FLAG
Are there any signs or
symptoms? Are there any risk factors?

≥ 2 NON- RED NO NO ≥ 2 NON- RED

FLAGS FLAGS

YES NEWS OBS AND CONSIDER YES

ANTIBIOTICS

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SCREENV1.2AND TREAT FOR SUSPECTED
Page
INFECTION
21 fo 21

Adapted from NICE Guideline CG149 Antibiotics for early-onset neonatal infection August 2012 by A.Radcliffe revised by Liz Mills Aug 16