risk factors for and clinical indicators of possible early-onset neonatal infection

Last edited 08/2022 and last reviewed 08/2022

Risk factors for and clinical indicators of possible early-onset neonatal infection

Before birth

  • for women in labour, identify and assess any risk factors for early-onset neonatal infection
Box 1 Risk factors for early-onset neonatal infection, including 'red flags'

Red flag risk factor:

  • Suspected or confirmed infection in another baby in the case of a multiple pregnancy.

Other risk factors:

  • Invasive group B streptococcal infection in a previous baby or maternal group B streptococcal colonisation, bacteriuria or infection in the current pregnancy.

  • Pre-term birth following spontaneous labour before 37 weeks' gestation.

  • Confirmed rupture of membranes for more than 18 hours before a pre-term birth.

  • Confirmed prelabour rupture of membranes at term for more than 24 hours before the onset of labour.

  • Intrapartum fever higher than 38°C if there is suspected or confirmed bacterial infection.

  • Clinical diagnosis of chorioamnionitis.

  • throughout labour, monitor for any new risk factors
Box 2 Clinical indicators of possible early-onset neonatal infection (observations and events in the baby), including 'red flags'

Red flag clinical indicators:

  • Apnoea (temporary stopping of breathing)

  • Seizures

  • Need for cardiopulmonary resuscitation

  • Need for mechanical ventilation

  • Signs of shock

Other clinical indicators:

  • Altered behaviour or responsiveness

  • Altered muscle tone (for example, floppiness)

  • Feeding difficulties (for example, feed refusal)

  • Feed intolerance, including vomiting, excessive gastric aspirates and abdominal distension

  • Abnormal heart rate (bradycardia or tachycardia)

  • Signs of respiratory distress (including grunting, recession, tachypnoea)

  • Hypoxia (for example, central cyanosis or reduced oxygen saturation level)

  • Persistent pulmonary hypertension of newborns

  • Jaundice within 24 hours of birth

  • Signs of neonatal encephalopathy

  • Temperature abnormality (lower than 36°C or higher than 38°C) unexplained by environmental factors

  • Unexplained excessive bleeding, thrombocytopenia, or abnormal coagulation

  • Altered glucose homeostasis (hypoglycaemia or hyperglycaemia)

  • Metabolic acidosis (base deficit of 10 mmol/litre or greater)

For detailed guidance then see NICE: Neonatal infection: antibiotics for prevention and treatment