Antibiotics for early-onset neonatal infection: a summary of the NICE guideline 2012

Authors

  • Moira A Mugglestone BSc MSc PhD FCMI,

    Director, Corresponding author
    1. National Collaborating Centre for Women's and Children's Health, Royal College of Obstetricians and Gynaecologists, Regent's Park, London, UK
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  • M Stephen Murphy BSc DCH MD FRCPI FRCPCH,

    Clinical Director for Children's Health, Senior Lecturer in Paediatrics and Child Health, Consultant Paediatric Gastroenterologist
    1. National Collaborating Centre for Women's and Children's Health, Royal College of Obstetricians and Gynaecologists, Regent's Park, London, UK
    2. College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham, UK
    3. Birmingham Children's Hospital, NHS Foundation Trust, Birmingham, UK
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  • Cristina Visintin PhD,

    Project Manager
    1. National Collaborating Centre for Women's and Children's Health, Royal College of Obstetricians and Gynaecologists, Regent's Park, London, UK
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  • David T Howe DM FRCOG FRCS(Ed),

    Consultant and Honorary Senior Lecturer in Feto-Maternal Medicine
    1. Wessex Fetal Medicine Unit, Princess Anne Hospital, Southampton, UK
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  • Mark A Turner BSc MBChB PhD MRCP(UK) MRCPCH DRCOG

    Senior Lecturer in Neonatalogy and Consultant in Neonatology
    1. Department of Women's and Children's Health, University of Liverpool and Liverpool Women's Hospital, Liverpool, UK
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Abstract

Key content

  • Early-onset neonatal infection (infection arising within 72 hours of birth) is an important cause of morbidity and mortality and is often caused by Streptococcus agalactiae (group B streptococcus [GBS]).
  • Identifying and assessing risk factors for early-onset neonatal infection before and during labour and birth is integral to clinical management.
  • Intrapartum antibiotic prophylaxis (IAP) to prevent early-onset neonatal infection is effective when given to women with particular risk factors, including maternal GBS colonisation.
  • When IAP is given specifically to prevent early-onset neonatal infection with GBS the National Institute for Health and Care Excellence (NICE) recommends using benzylpenicillin.
  • Alternative antibiotic regimens are appropriate for women who are allergic to penicillin or where local microbiological surveillance data indicate antibiotic resistance.

Learning objectives

  • To be aware of the risk factors for early-onset neonatal infection.
  • To understand how IAP can reduce the risk of an early-onset neonatal infection.
  • To know which antibiotic to use for IAP of GBS.

Ethical issues

  • How should decisions about whether to administer IAP trade off the potential benefit to the baby of preventing an early-onset neonatal infection and potential harms to the woman, such as, allergic reactions and increased medicalisation of pregnancy?
  • How should decisions about the choice of antibiotics used in intrapartum prophylaxis take account of the risk of promoting antibiotic resistance?

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