Management of early-onset neonatal infections.

Early-onset neonatal infection (EONI) refers to an infection arising within first 72 h after birth. In August 2012, the National Institute of Health and Care Excellence (NICE) published guideline on the use of antibiotics to prevent and treat early-onset bacterial infection in newborn babies. Key recommendations included treating suspected EONI as quickly as possible and minimise antibiotic exposure in babies who do not have EONI. NICE recommends measuring C-reactive protein (CRP) at presentation when starting antibiotics and repeating CRP 18–24 h later. Furthermore, it suggests stopping antibiotics at 36 h if baby is clinically well, blood culture (BC) is negative and CRP values/trends are reassuring. Prior to the publication of NICE guidance, our practice was to perform BC and CRP before commencing antibiotics for all suspected cases of EONI. Antibiotics were stopped if baby remained clinically well and BC was negative after 48 h. We modified our local care pathway in accordance with NICE guideline in 2013. A service evaluation was carried out in March 2014 to compare our practice before and after the implementation of NICE guideline on EONI. We compared two groups of babies born over a 4-month period each. We looked at hospital record and laboratory data of 43 babies born in 2012 (group A) before implementation of NICE guideline locally and compared it with 36 babies born in 2013 (group B) who were managed as per NICE guideline on EONI. We looked at their initial investigations including CRP, full blood count