Babies with suspected infection (also known as Early Onset Neonatal Infection)
Information for parents from the Neonatal Team
This leaflet will help you understand more about why your baby has been started on antibiotics on the postnatal ward. It outlines what to expect in the following days.
We hope this leaflet answers some of the questions you may have. If you have any further questions or concerns, please speak to a member of your baby's medical team.
What is an early onset neonatal infection?
Most babies are born healthy, but some can develop a bacterial infection before, during, or shortly after birth. A bacterial infection is when harmful bacteria enters the body, multiplies and causes an illness.
If an infection occurs within the first 72 hours of life, it is known as an early onset neonatal infection. These infections can be serious. Starting antibiotics quickly is the best way to ensure the health of babies at risk.
An infection in a newborn baby can spread quickly, and lead to a condition known as sepsis. Sepsis is a severe infection that spreads throughout the body.
How is the infection diagnosed?
A clinician has reviewed your baby. They have determined that the risk of infection is high enough that your baby needs:
blood tests to check for signs of infection in their blood; and
to start on antibiotics to treat a potential infection.
Your baby is well enough to remain with you on the postnatal ward, but they will be monitored closely. The Neonatal team will check your baby every day. If you have any concerns about the health of your baby during this time, please immediately tell a member of the medical team looking after your baby.
Where did the infection come from?
Infections in babies can happen for many different reasons, including the following.
The waters (amniotic fluid) around the baby leak for more than 24 hours before baby is born.
The mother is a carrier of a bacteria called Group B Streptococcus (GBS).
The mother is unwell at the time of baby's delivery.
The water (amniotic fluid) around baby is infected.
Premature babies (those born before 37 weeks of pregnancy) are more likely to get an infection. Their immune systems are not fully developed, making it harder for them to fight off infections.
In some cases, the reason a baby is born early is because of an infection during pregnancy. This means that the baby could have already been exposed to an infection before birth. Some mothers are given antibiotics in labour to try to stop infection. However, in order for them to work, antibiotics need to be given at least 4 hours before baby is born. This is not always possible.
In some cases, we are not sure where the infection has come from. However, your baby may need treatment if they show signs of being unwell, such as:
being very lethargic (sluggish)
not feeding well
poor colour
poor temperature control, and
fast breathing
If you have any concerns, please speak to a member of your baby’s medical team.
What are the tests and treatment for early onset neonatal infection?
The best way to treat a possible infection in your baby is by giving antibiotics through a small tube (called a cannula) placed in a vein in their hand or foot. This is called intravenous (IV) antibiotics. The cannula is usually inserted in a treatment room:
on the Neonatal Unit if you are at William Harvey Hospital (WHH); or
the Special Care Baby Unit (SCBU) at Queen Elizabeth the Queen Mother (QEQM) Hospital.
There may be some discomfort during this procedure. We encourage parents to stay with their baby to soothe them while the cannula is inserted. However, you do not have to be present for this procedure. To help comfort your baby, we use:
oral sucrose (sweet solution) for pain relief;
your expressed colostrum, if available; and
gentle holding and comforting during the procedure.
When inserting the cannula, we will also take blood tests to look for signs of infection. These include looking at:
infection markers known as the C Reactive Protein (CRP);
having a Full Blood Count (FBC); and
a test to see if any bacteria are growing in the blood (known as a blood culture).
Test results from the CRP and FBC are available in 2 to 3 hours. Blood culture results will take approximately 36 to 48 hours. The CRP blood test is repeated approximately 30 hours after the first test.
These tests help us figure out if your baby has an infection, what kind it is, and how long they will need antibiotics. A member of the Neonatal team will be able to update you with these results, as and when they become available.
Will I be separated from my baby?
If your baby is well enough, they can stay with you on the postnatal ward.
Antibiotics are given twice a day (either at 6am and 6pm, or at 12am and 12pm) for at least 36 to 48 hours. Antibiotics will be given by the neonatal nurses on the Neonatal Unit at WHH or the Special Care Baby Unit at QEQM. Parents are welcome to remain with their baby when they are having their antibiotics.
What antibiotics are used? And, what are the side-effects?
Your baby will be given two antibiotics - Benzylpenicillin and Gentamicin. They are very effective at treating common bacterial infections in newborn babies.
Benzylpenicillin is given twice a day, and Gentamicin is usually given every 36 hours. These antibiotics are safe and routinely used for newborn babies.
Benzylpenicillin is safe to give your baby, even if you have a family history of penicillin allergy.
Gentamicin can very rarely affect hearing or kidney function. To keep your baby safe, we check the level of Gentamicin in their blood before giving the second dose.
If the level is high, we will wait another 12 hours, before checking the level of Gentamicin in the blood again. If the repeat level remains high, a doctor or nurse will explain what will happen next. Including further blood tests to check the level of Gentamicin. If the level is normal we will give the next dose of Gentamicin.
All babies have a newborn hearing screen before they leave hospital. Babies with raised Gentamicin levels will have another hearing screen with the Audiology team in 6 months.
We will monitor the kidney function in babies with a high Gentamicin level by checking how many wet nappies they are producing.
Will further tests be necessary?
If your baby continues to show signs of ill health, they may need to have repeat blood tests. If there is a significant increase in the CRP, or a positive blood culture, further tests may be necessary. A member of the Neonatal team will discuss this with you.
How long will I need to stay in hospital with my baby?
You and your baby will need to stay in hospital for at least 48 hours. After 48 hours all the blood test results should be back.
We can consider stopping antibiotics if the results do not show signs of infection and your baby is well. However, antibiotic treatment may continue for at least 5 days in total, and longer in certain circumstances, if:
your baby appears unwell; or
the tests show any signs of infection.
Are there any alternatives?
At this time, there is no recommended alternative to starting intravenous (IV) antibiotics for your baby.
If an infection is not treated quickly, it can become serious. It may lead to long-term complications or become life-threatening.
What should I do when we get home?
Once their treatment is finished, most babies will not need any follow-up with a doctor. They will be like any other newborn baby.
There is a small chance of your baby developing a late infection in the first 6 weeks of life, despite having antibiotics. This is more likely if the mother had group B streptococcus (GBS) during pregnancy.
When your baby goes home after treatment, it is important to look for the following signs that they may be unwell.
Constant crying or weak, high-pitched cry.
Does not wake, or if woken-up does not stay awake.
Fast breathing or difficulty breathing.
Floppiness.
Trouble feeding or vomiting.
Temperature of 38°C or above.
Temperature 36°C or below.
Changes in skin colour, such as looking blue, or having a mottled or non-blanching rash.
If you notice any of these signs, please contact your GP straight away for advice. If you are not able to speak to your GP, please call 111 or go to your nearest Emergency Department.
If you see a doctor about your baby, it is important to tell them that your baby was given antibiotics when they were first born and why.
If your baby received antibiotics in hospital, your GP will be sent a letter with the details of their treatment and test results. Please make sure to register your baby with a GP as soon as possible after going home.
Further information
[Web sites last accessed 17 October 2025]
If you have any questions or concerns, please do not hesitate to ask your midwife or paediatric doctor.
References
[Web site last accessed 17 October 2025]
We have used the term ‘mother’ throughout this leaflet. When we use this term we also mean people with female reproductive organs who do not identify as a mother. East Kent Hospitals is committed to supporting people of all gender identities. Please tell your midwife or doctor how you would like them to address you, so we can be sure to get this right.
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