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NICE guideline review: neonatal infection: antibiotics for prevention and treatment (NG195)
  1. Siba Prosad Paul1,
  2. Henna Khattak1,
  3. Prashant Karkala Kini1,
  4. Paul Anthony Heaton1,
  5. Nitin Goel2
  1. 1 Paediatrics, Yeovil District Hospital, Yeovil, UK
  2. 2 Neonatal Medicine, University Hospital of Wales, Cardiff, UK
  1. Correspondence to Dr Siba Prosad Paul, Paediatrics, Yeovil District Hospital, Yeovil BA21 4AT, UK; siba.paul{at}

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Neonatal infection has been recognised as the third most common cause of neonatal death globally.1 In the UK, a retrospective analysis that spanned over 30 neonatal units from 2005 to 2014 found the incidence of neonatal infection was 6.1 per 1000 live births and 48.8 per 1000 neonatal admissions.2 The incidence of early-onset neonatal sepsis (EONS) in the UK was 0.7 per 1000 live births.2

The National Institute for Health and Care Excellence (NICE) published the first guideline (CG149) intended for management of early-onset sepsis in 2012; this has been updated (NG195) in 2021.3 The guideline refers to the use of Kaiser Permanente Sepsis Risk Calculator (KPSRC), which applies a multivariable modelling approach to predict individualised risk of EONS.4 The KPSRC has been used widely across the world; published reports indicate a significant reduction in antibiotic use without missing true cases of EONS.4–6

Information about the current guideline

The current guideline (NG195) provides new recommendations for intrapartum antibiotics and details the risk factors for infection. It refers to the assessment of risk using the KPSRC, lists the clinical indicators of possible infection and recommends management of late-onset neonatal sepsis (LONS).

This guideline should be used in conjunction with existing NICE guidelines on meningitis (bacterial) and meningococcal septicaemia in under 16s (CG102), urinary tract infection (CG54), sepsis (NG51), fever in under 5s (NG143) and specialist neonatal respiratory care for babies born preterm (NG124) (see box 1).

Box 1


  • Neonatal infection: antibiotics for prevention and treatment (National Institute for Health and Care Excellence guideline 2021):

  • Fever in under 5s: assessment and initial management (National Institute for Health and Care Excellence guideline 2019):

  • Sepsis: recognition, diagnosis and early management (National Institute for Health and Care Excellence guideline 2016):

  • Neonatal infection (early onset): antibiotics for prevention and treatment (National Institute for …

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  • Contributors SPP, HK and PKK planned and wrote the paper and revised the subsequent drafts. PAH and NG provided their expert opinion and helped in editing the manuscript. All authors have approved the final draft.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Commissioned; externally peer reviewed.