Aims NICE projected cost savings of £50 million per annum with its guideline on “Antibiotics for early-onset neonatal infection’. We assessed the impact of implementing this guideline in a Level 2 Neonatal Unit.
Method Retrospective case notes review of neonates born in our hospital who received antibiotics within 72 h of birth. We compared a pre-guideline implementation cohort (March–April 2012) and a post-guideline cohort (March–April 2013). Data on characteristics of the neonates, reasons for starting antibiotics, length of antibiotics course and adherence to the guidelines were collected.
Results 138 neonates were identified, 57 in the pre-guideline cohort and 81 in the post-guideline cohort (Figure 1). From the pre-guideline cohort, 39 were included. From the post-guideline cohort, 59 were included. The cohorts were matched. Overall, post-guideline implementation, there is a 51% increase in the number of neonates receiving antibiotics, with the main reason being for neonatal signs and symptoms in both cohorts (72% and 77%) (Figure 2). However, there was a 9% rise in neonates being started on antibiotics because of maternal risk factors alone in the post guideline cohort. This is due to the increasing number of mothers started on intravenous antibiotics for suspected invasive bacterial infection, although the criteria defining ‘suspected invasive bacterial infection’ are unclear. Post-guideline implementation, the number of neonates receiving more than 48 h of antibiotics increased from 44% to 68%, due to our microbiology laboratory operating on a 48 h reporting system for specimen cultures as opposed to 36 h as suggested by NICE (Figure 3). More neonates with negative blood cultures but with elevated C-reactive protein (CRP) were receiving longer courses of antibiotics. Performing lumbar puncture if the CRP >10 mg/L resulted in a 16% increase in the number performed, with no significant clinical impact (Figure 4).
Implementation of NICE guidelines in our unit has resulted in increased cost due to more neonates receiving antibiotics for longer duration. In order to achieve NICE’s cost saving projections, further clarification on criteria for starting maternal intravenous antibiotics is needed, as is a clearer definition of ‘strong suspicion of sepsis’ in neonates with negative blood culture, and a change in hospital laboratory reporting protocol.
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