Background Early onset neonatal infection (EONI) is serious but uncommon. In England c. 10% of babies are treated for suspected EONI but practice varies significantly. The National Institute for Health and Clinical Excellence has developed guidelines for England.

Methods The guideline was developed according to the procedures in the NICE Guidelines Manual (2009).

Results The principles underlying the recommendations were: a) start antibiotics as quickly as possible; b) minimize the extent of antibiotic exposure in babies without an infection; c) continuous assessment of blood culture status in automated systems provides reliable information about whether a significant isolate is present; antibiotics can be stopped safely if blood cultures are negative 24–36 hours after they are taken. The key recommendations relate to: 1. The early administration of antibiotics; 2. The timely cessation of antibiotics if blood cultures are negative, the baby is well and a CRP measurement c. 24 hours after the start of antibiotics is normal; 3. The value of investing in information technology to support timely reporting of blood culture results to clinical areas because improved systems are likely to pay for themselves through reductions in hospital stay.

Conclusion The severity of EONI requires urgent action at the first suspicion of infection. Modern laboratory technology allows an early cessation of antibiotics in the majority of babies who are not infected.