title: NICE neonatal early onset sepsis guidance: greater consistency, but more investigations, and greater length of stay.
abstract: BACKGROUND
  In August 2012, new national guidance (National Institute of Health and Care Excellence (NICE) CG149) for management of early onset sepsis (EOS) was introduced in the UK. The guidance outlined a consistent approach for septic screens in newborn infants based on risk factors, and suggested biochemical and clinical parameters to guide management. In particular, it advised a second C-reactive protein level (CRP) 18-24 h into treatment to help determine length of antibiotic course, need for lumbar puncture (LP), and suggested review of blood culture at 36 h.
  
  
  OBJECTIVE
  We evaluated impact of this guidance in our neonatal unit.
  
  
  METHODS
  We compared two time periods, before and following the guidance. We evaluated length of stay, second CRP 18-24 h into treatment, percentage of babies having LP and duration of antibiotics.
  
  
  RESULTS
  Before NICE guidance, 38.1% of screened babies stayed <72 h. This reduced to 18.4% following guidance. Before guidance, 20.9% babies stayed >5 days, which increased to 27.7% following NICE recommendations. Repeat CRP measurements increased from 45% to 97%. In 58% of these babies, repeat CRPs influenced management and hospital stay. An increase in LPs performed from 14% to 23% was noted. There were no positive blood cultures or LP results.
  
  
  CONCLUSIONS
  We envisaged shorter hospital stays with new NICE standards, particularly, with the aim of 36 h blood culture reporting. However, repeat CRP led to further investigations, increased LPs and longer durations of treatment and stay. This, in turn, impacted on workload and cost, and influenced parental experience in the first few days of life.
authors: Department of Neonatology, St Georges University Hospital, London, UK.
authors: Arindam
authors: A
authors: Mukherjee
authors: Department of Neonatology, St Georges University Hospital, London, UK.
authors: Louise
authors: L
authors: Davidson
authors: Department of Neonatology, St Georges University Hospital, London, UK.
authors: Lazarus
authors: L
authors: Anguvaa
authors: Department of Neonatology, St Georges University Hospital, London, UK.
authors: Donovan Alistair
authors: DA
authors: Duffy
authors: Department of Neonatology, St Georges University Hospital, London, UK.
authors: Nigel
authors: N
authors: Kennea
mesh_terms: D017668:Age of Onset; D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D002097:C-Reactive Protein / Q000032:analysis; D004334:Drug Administration Schedule; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D007231:Infant, Newborn; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D017410:Practice Guidelines as Topic; D012189:Retrospective Studies; D012307:Risk Factors; D018805:Sepsis / Q000097:blood / Q000188:drug therapy*; D013129:Spinal Puncture / Q000706:statistics & numerical data; D006113:United Kingdom
chemical_list: D000900:Anti-Bacterial Agents; D002097:C-Reactive Protein
keywords: Infectious Diseases; Neonatology