Guidelines endorsed by RCPCH - Neonatology

The College reviews high quality guidelines and standards produced and published by other organisations against the RCPCH Standards for Endorsement. We believe the following will be of interest to those working in neonatology.

The following have been endorsed by the College.

Endorsed guidelines

Quick links:

Antibiotics for neonatal infection (NICE)

Neonatal infection is a significant cause of mortality and morbidity in newborn babies, and may be early-onset or late-onset. Neonatal infection can lead to life-threatening sepsis and accounts for 10% of all neonatal mortality. 
 
This quality standard covers the use of antibiotics to prevent and treat infection in newborn babies from birth to 28 days in both primary and secondary care. This standard includes antibiotics given to newborn babies, or mothers, during intrapartum care in order to prevent neonatal infection (antibiotic prophylaxis).
 
This quality standard is expected to contribute to improvements in the following outcomes:
  • infant mortality
  • admissions and readmissions to neonatal care units
  • maternity and neonatal length of hospital stay
  • neonatal neurological and auditory development
Date of Publication: December 2014
Endorsed on: May 2015
 
Full quality standard (PDF, 236KB, 43 Pages)
 

Antibiotics for Early Onset of Neonatal Infection (NICE NCC-WCH)

This clinical guideline offers evidence-based advice on the use of antibiotics to prevent and treat early-onset neonatal infection (infection with onset within 72 hours of birth). It includes a review of the risk factors for infection, clinical indicators of possible infections and investigation before starting antibiotics. The guideline covers recommendations about choice of antibiotics, duration of course and therapeutic monitoring.  
 
This guideline is particularly relevant to healthcare professionals who work within the acute and primary healthcare sectors who have direct contact with postnatal women and their babies, those responsible for commissioning and planning healthcare services, public health and trust managers and women who have recently given birth, their partners, families and other carers.
 
RCPCH Notes:
 
This national clinical guidance is very welcomed. The guideline presents recommendations for practice within the limit of current evidence. Much of the guideline is consistent with current practice and many elements of good practice are highlighted. However, There is a lack of evidence for some of the recommendations which have therefore been reached by consensus expert opinion.
 
Date of Publication: August 2012
Date of Endorsement: August 2012 (badged September 2014)
 
Full Guideline (PDF, 172KB, 39 Pages)
 

Antimicrobial stewardship (NICE)

This quality standard covers the effective use of antimicrobials (antibacterial, antiviral, antifungal and antiparasitic medicines) to reduce the emergence of antimicrobial resistance (loss of effectiveness of antimicrobials).

It covers all settings, all formulations of antimicrobials (oral, parenteral and topical agents) and is for health and social care practitioners, organisations that commission, provide or support the provision of care, as well as people using antimicrobials and their carers.

RCPCH notes:

The College endorses the quality standards and notes that the document would have benefitted from specifying the route of administration and by adding a reminder that sometimes more than one microbiological sample (or none) might be need to be collected. The option of offering back-up (delayed) prescribing in Primary care would have been preferred to be suggested as a last resort and only in situations where the doctor has a clear opinion as to a likely bacterial cause of an illness that may not be self-limiting.

Date of Publication: April 2016 
Endorsed on: August 2016

Full Quality Standard (PDF, 177KB, 39 Pages)
 

Antenatal Care: Routine Care for the Healthy Pregnant Woman (NICE)

This guideline covers the routine antenatal care of pregnant women with an uncomplicated singleton pregnancy. It provides information on best practice for baseline clinical care of all pregnancies and comprehensive information on the antenatal care of the healthy woman with an uncomplicated singleton pregnancy.

The guideline is accompanied by a quick reference guide, information for women and their carers, costing tools, slides highlighting the key messages and implementation advice and includes key priorities for implementation and an antenatal assessment tool to group women into high risk and low risk categories.

Date of Publication: March 2008 
Date of Endorsement: April 2008

NICE guideline (PDF, 209KB, 56 Pages)
 

Bacterial Meningitis and Meningococcal Septicaemia in Children (NICE)

This NICE quality standard defines clinical best practice within this topic area. It provides specific, concise quality statements, measures and audience descriptors to provide the public, health and social care professionals, commissioners and service providers with definitions of high-quality care.

This quality standard covers the diagnosis and management of children and young people (younger than 16 years) with bacterial meningitis or meningococcal septicaemia.

Date of Publication: June 2012
Date of Endorsement: July 2012

Full quality standard (PDF, 257KB, 50 Pages)
 

Bacterial Meningitis and Meningococcal Septicaemia in Children (NICE)

The guideline covers the diagnosis and management of bacterial meningitis and meningococcal septicaemia in children and young people under 16 years in primary and secondary care.

The guideline is accompanied by a quick reference guide, parent/carer version, audit tools and algorithms.

RCPCH notes:

Please note that since publication of the guideline:

  • NICE have updated the quick reference guide to reflect the action required when meningococcal meningitis is confirmed in children older than 3 months. Please see the NICE website for further information.
  • Recommendation 1.4.45 has been amended from

'In children and young people with shock that is unresponsive to vasoactive agents, steroid replacement therapy using low-dose corticosteroids (hydrocortisone 0.25mg/m2 four times daily) should be used only when directed by a paediatric intensivist.'

To:

'In children and young people with shock that is unresponsive to vasoactive agents, steroid replacement therapy using low-dose corticosteroids (hydrocortisone 25mg/m2) four times daily) should be used only when directed by a paediatric intensivist.'

Date of Publication: June 2010
Date of Endorsement: June 2010

Full guideline (PDF, 5.90MB, 275 Pages)
NICE guideline (PDF, 294KB, 45 Pages)
Press release (PDF, 47KB, 6 Pages)
 

When to Suspect Child Maltreatment (NICE)

This guidance covers the clinical features (including physical and psychological symptoms) associated with maltreatment which may be observed by health professionals when a child presents to them. It is aimed at all health professionals, including GPs, primary health and child health teams, professionals groups who are routinely involved in the care of children and families and those who may encounter children in the course of their professional duties.

The guideline is accompanied by a quick reference guide, costing tools, slides highlighting the key messages, audit support tools and an educational tool.

The RCPCH welcomes the publication of this valuable and important guidance and fully endorses it. The College notes that:

  • The NICE guideline uses less technical terms which in some areas may appear to differ from RCPCH documents. This is because the intended audience of the NICE guideline is front line health professionals rather than specialist paediatricians (although the guideline is of relevance to paediatricians also).

Please note: As of December 2009, recommendation 5.8 on inappropriately explained school attendance has been amended. This recommendation has been changed from:

"Consider child maltreatment if a child has poor school attendance that the parents or carers know about that has no justification on health, including mental health, grounds and formally approved home education is not being provided."

to:

"Consider child maltreatment if a child has poor school attendance that the parents or carers know about that has no justification on health, including mental health, grounds and home education is not being provided."

Date of Publication: July 2009
Date of Endorsement: July 2009

Full guideline (PDF, 1.48MB, 156 Pages)
NICE guideline (PDF, 372KB, 39 Pages)
Key messages (PDF, 235KB, 12 Pages) 
RCPCH press statement (PDF, 37KB, 1 Page)
 

Physical Signs of Child Sexual Abuse (RCPCH)

This handbook is a revision of the 1997 RCP publication 'Physical Signs of Sexual Abuse in Children' and is based on the best available evidence. The review focuses on evidence for the physical signs of CSA in the following areas: female genitalia, male genitalia, anal signs, oral signs and sexually transmitted infections.

This was developed with The Royal College of Physicians of London and its Faculty of Forensic and Legal Medicine.

This handbook is available free of charge to all named and designated doctors and otherwise for purchase.

Date of Publication: April 2008
Date of Endorsement: April 2008

Further information can be found here
 

Constipation in Children and Young People (NICE)

This guideline covers the diagnosis and management of idiopathic constipation in children up to 18 years of age in primary and secondary care.

The guideline is accompanied by a quick reference guide, audit support, a baseline assessment tool, slide set and parent/carer version.

RCPCH notes:


The RCPCH welcomes publication of this guideline but asks Members to note:

  • Although not explicit in the NICE guideline, the College thinks that the goals of treatment should include 'no pain' and 'no overflow'.
  • The guideline recommends some dosages which vary from those recommended in the British National Formulary for Children (2009 Edition). These are highlighted in the guideline. Please note that the BNF-c has been updated since publication of the guideline in 2010.

Date of Publication: June 2010
Date of Endorsement: June 2010

Full guideline (PDF, 2.55MB, 255 Pages)
 

Donor Breast Milk Banks (NICE)

The guideline covers the operation of donor breast milk services, including the recruitment of donors, expressing and handling of donor breast milk and testing and treating donor breast milk. The guideline does not make recommendations relating to the configuration of donor breast milk services.

The guideline is accompanied by a quick reference guide, audit support, costing statement, slide set, an implementation briefing and a baseline assessment tool.

RCPCH notes:

The RCPCH welcomes the publication of this guideline which focuses on the operation of donor milk banks (that is, the handling of milk).

  • The College would like to emphasise that siting donor breast milk in one site within a neonatal network would avoid duplication of resources.

Date of Publication: February 2010
Date of Endorsement: June 2010

Full guideline (PDF, 950KB, 132 Pages)
Quick reference guide (PDF, 99KB, 16 Pages)
 

Gastro-oesophageal reflux disease (GORD) in children and young people (NICE QS)

GOR is a normal physiological process that usually happens after eating in healthy infants, children, young people and adults. In contrast, GORD starts when symptoms of reflux become severe and need medical treatment. 
 
GOR and GORD affect many children and families in the UK, who commonly seek medical advice. In clinical practice, it may be difficult to differentiate between GOR and GORD. There is no reliable and accurate diagnostic test to confirm whether the condition is GOR or GORD, and this affects research and clinical decisions. The term GORD covers a number of specific conditions that have different effects and present in different ways - this makes it difficult to identify GORD and to estimate its real prevalence.
 
This quality standard covers managing symptoms of gastro-oesophageal reflux (GOR) and recognising, diagnosing and managing gastro-oesophageal reflux disease (GORD) in children and young people under 18. It contributes to improvements in the following outcomes:
  • Change in symptoms and signs
  • Investigative findings, including healing of erosive oesophagitis
  • Adverse events of interventions (diagnostic or treatment)
  • Unnecessary prescribing
Date of Publication: January 2016
Endorsed on: Febraury 2016
 
Full quality standard (PDF, 165KB, 34 Pages) 
 

Gastro-oesophageal reflux disease (GORD) in children and young people (NICE CG)

Gastro‑oesophageal reflux (GOR) is a normal physiological process that usually happens after eating. In contrast, gastro‑oesophageal reflux disease (GORD) occurs when the effect of GOR leads to symptoms severe enough to merit medical treatment. GOR is more common in infants than in older children and young people, and it is noticeable by the effortless regurgitation of feeds in young babies.
 
This clinical guideline focuses on signs and symptoms and interventions for GORD. Where appropriate, clear recommendations are given as to when and how reassurance should be offered. The clinical guideline also advises healthcare professionals about when to think about investigations, and what treatments to offer.
 
Date of Publication: January 2015
Endorsed on: February 2015
 
NICE clinicl guideline (PDF, 165KB, 34 Pages)
Full clinical guideline (PDF, 3,089KB, 218 Pages)
 

Use of Home Oxygen in Children (BTS)

The guideline covers the practice of administering supplemental oxygen to children outside hospitals and makes recommendations for best practice. It is based on available evidence published up to March 2008 and informal consensus.

The guideline is accompanied by an algorithm and quick reference guide, and includes key priorities for audit.

The RCPCH welcomes the publication of this guideline but asks Members to note the following:

  • The guideline is particularly useful given that existing guidelines focus on adult home oxygen users, who unlike paediatric users are often housebound.
  • The recommendations are not likely to represent a significant change from existing practice. However, implementation of the guideline may have resulting cost implications should children who meet the criteria for home oxygen be discharged from children's wards and neonatal units at an earlier time.
  • The following correction to the guidelines have been made:- Page ii4 - The recommendation in the summary of recommendations (section 6, bullet point 5) should read: Continuously delivered liquid flow oxygen at flows <0.25 l/min is only available from one oxygen supply company which limits its application in children
    - Page ii18 - The recommendation for section 6.2.3 should read (bullet point 1): Continuously delivered liquid oxygen at flows <0.25 l/min is only available from one oxygen supply company which limits its application in children
    - Page ii18 - The recommendation for section 6.2.3 (bullet point 5): However, there are a number of disadvantages for the use of liquid oxygen especially with a paediatric population: Currently low flow rates (<0.25 l/min) for continuously delivered liquid is only available from one oxygen supply company in the UK (Air Liquide), which limits its use in children in the UK.
    - The sentence at bullet point 6 should be deleted.

Date of Publication: July 2009
Date of Endorsement: April 2009

Full guideline (PDF, 863KB, 29 Pages)
Quick reference guide (PDF, 110KB, 8 Pages)
 

Establishment and Operation of Human Milk Banks in the UK (UKAMB)

The guidelines provide comprehensive advice to those operating human milk banks. The recommendations should be used for quality assuring the operation of milk banks.

Date of Publication: September 2003
Date of Endorsement: September 2003

Full guideline (PDF, 4.45MB, 57 Pages)
 

Hypertension in Pregnancy (NICE)

The guideline covers the diagnosis and management of hypertensive disorders during the antenatal, intrapartum and postnatal periods. It also contains recommendations for advice to women who wish to conceive and suffer from chronic hypertension, as well as advice to women after a pregnancy complicated by hypertension.

The guideline is accompanied by a quick reference guide, guidance for patients and carers, audit support, a costing report, a baseline assessment tool, a slide set and a costing template.

Date of Publication: August 2010
Date Endorsed: October 2010

Full guideline (PDF, 2.98KB, 296 Pages)
NICE guideline (PDF, 311MB, 47 Pages)
 

Intravenous fluid therapy in children and young people in hospital

Correct fluid and electrolyte balance is essential to maintain normal physiological function in humans. Normally, children are able to maintain their fluid requirements through drinking. However, many children admitted to hospital may be too ill to drink and may require intravenous (IV) fluid therapy to maintain correct fluid and electrolyte balance. 
 
Children may need IV fluids to account for losses of red blood cells, plasma, water or electrolytes, beyond the usual losses in urine, stools and sweat. These losses can occur via the loss of blood, plasma and other fluids resulting from burns, diarrhoea, vomiting or leakage of fluid from the circulation into the interstitial space. In these situations, the aim is to replace any depleted fluids and restore associated electrolyte imbalances. 
 
This clinical guideline contains recommendations about general principles for managing intravenous (IV) fluids in children and young people under 16 years, and aims to help prescribers understand the:
  • indications for IV fluid therapy
  • reasons for the choice of the various fluids available
  • prevention and treatment of sodium imbalance
  • principles of assessing fluid balance
  • training and education needs of those prescribing IV fluids.
Date of Publication: December 2015
Endorsed on: February 2016
 
NICE clinical guideline (PDF, 142KB, 33 Pages) 
NICE full clinical guideline (PDF, 1,421KB, 33 Pages)
 

Induction of Labour (NICE)

This guideline covers all aspects of the methodology of induction of labour and the appropriateness of different approaches in the various clinical circumstances that may call for such an intervention. The guideline is accompanied by a quick reference guide, information leaflet, costing report, support tool and slide set and includes audit criteria, a service user questionnaire and algorithm.

Date of Publication: July 2008
Date of Endorsement: January 2009

Full guideline (PDF, 1.22MB, 124 Pages)
NICE guideline (PDF, 241KB, 33 Pages)
 

Jaundice in newborn babies under 28 days (NICE)

Jaundice is one of the most common conditions needing medical attention in newborn babies; approximately 60% of term and 80% of preterm babies develop jaundice in the first week of life. For most babies, this early jaundice is not a sign of underlying disease and is generally harmless. 
 
Breastfed babies are more likely than formula-fed babies to develop physiological jaundice within the first week of life. 
 
This quality standard covers the recognition and management of neonatal jaundice in newborn babies (both term and preterm) from birth to 28 days in primary care (including community care) and secondary care. 
 
Date of Publication: March 2014
Endorsed on: October 2015
 
Full quality standard (PDF, 144KB, 29 Pages)
 

Neonatal Care (NICE)

This quality standard defines what excellent specialist neonatal care should look like. It has been produced in collaboration with the NHS and social care professionals, along with their partners and service users.

Date of Publication: October 2010
Date of Endorsement: October 2010

Full quality standard (PDF, 193KB, 36 Pages)
 

Neonatal Jaundice (NICE)

The guideline covers the recognition, assessment and treatment of neonatal jaundice as well as the prediction of later significant hyperbilirubinaemia and adverse sequelae in babies from birth until 28 days of age.

The guideline is accompanied by a quick reference guide, guidance for parents and carers, audit support tools, costing tools, a factsheet, treatment threshold graphs, a slide set and a baseline assessment tool.

The RCPCH welcomes the publication of this guideline but asks Members to note the following:

  • The scope of the guideline does not cover infants with jaundice lasting beyond the first 28 days.

Date of Publication: May 2010
Date of Endorsement: June 2010

Full guideline (PDF, 7.64MB, 525 Pages)
NICE guideline (PDF, 1.21MB, 54 Pages)
 

Neonatal Respiratory Distress Syndrome (BAPM)

The guideline contains both evidence-based recommendations on the obstetric and neonatal prevention and the neonatal management of respiratory distress syndrome in pre-term infants, the guidance on neonatal management being described in considerable detail.

The guideline includes implementation advice.

RCPCH notes: 

This guideline has been replaced by Early Care guidance, also produced by the British Association of Perinatal Medicine.

Date of Publication: November 1998
Date of Endorsement: November 1998

Full guideline (PDF, 175KB, 29 Pages)
 

Organ Donation for Transplantation (NICE)

This guideline recognises the complexities that arise owing to the majority of potential adult and paediatric organ donors lacking the capacity to be directly involved in decision making at the time of their death. It covers strategies for improving donor identification and consent rates for deceased organ donation.

RCPCH notes:

The College asks members to note that:

  • There are few data on the validity of trigger tools in paediatric practice. NICE’s response to this comment is as follows: ‘The GDG made their decisions using the best available evidence, and where this was not available or lacking, the GDG based their recommendations on their clinical experience.’ It should be noted that NICE has deemed the best evidence from studies investigating conversion of patients displaying clinical triggers into organ donors is of very low quality.
  • Explicit reference to contraindications to donation from a paediatric perspective is not covered by the guideline.  This is because the GDG agreed that contraindications should not be included due to the rapid pace at which changes to contraindications occur particularly in paediatric patients.

Date of Publication: December 2011
Date of Endorsement: February 2012

Full guideline (PDF, 168KB, 26 pages)
Appendices
 

Palate examination: Identification of cleft palate in the newborn (RCPCH)

This guidance provides recommendations to health care professions for optimal examination of the palate during the routine newborn examination to ensure early detection of a cleft palate. 

The guidance was developed by the RCPCH, in collaboration with key partners, to aid neonatologists, paediatricians, nurses, midwives, GPs, health care assistants and any other health care professional to identify cleft palate in neonates, as well as to improve and standardise routine postnatal examination of the palate.

A parent/carer guide has also been developed.

Date of publication: October 2014
Date of endorsement: October 2014

More about palate examination guideline and parent information
 

Practical Guidance for the Management of Palliative Care in Neonatal Units

This guideline covers all aspects of the management of palliative care on neonatal units and focusses on practical aspects of infant care. It includes details on pain relief, symptom relief, comfort and dignity, the management of prognostic uncertainties, and the provision of support.

Developed by members of the multidisciplinary neonatal medicine team at Chelsea and Westminster NHS Foundation Trust, in collaboration with the Royal College of Paediatrics and Child Health, this guideline, which complements existing resources, equips staff working on a neonatal unit with a clear set of principles to underpin the care they provide to babies in life-limited situations and support parents.

The project is supported by a wide group of stakeholders including ACT, APPM, BAPM, BLISS, RCM, RCN, SANDS and the UK Neonatal Networks.

Date of Publiction: February 2014
Date of Endorsement: February 2014

Full guideline (PDF, 714KB, 40 Pages)
Supporting documents are available from the Chelsea and Westminister Hospital
 

Postnatal Care (NICE)

This quality standard covers postnatal care, which includes the core care and support that every woman, their baby and if appropiate, their partner and family should receive during the postnatal period. This includes recognizing women and babies with additional care needs and referring them to specialist services.

Date of Publication: July 2013
Date of Endorsement: October 2013

Full quality standard (PDF, 244KB, 64 Pages)
 

Postnatal Care of Women and their Babies (NICE)

This guideline covers infant and maternal care in the period following transfer from intrapartum care, or in the case of birth at home, the end of intrapartum care until the end of the postnatal period. It is particularly relevant to healthcare professionals who work within the acute and primary healthcare sectors who have direct contact with postnatal women and their babies, those responsible for commissioning and planning healthcare services, public health and trust managers and women who have recently given birth, their partners, families and other carers.

The guideline is accompanied by a quick reference guide, information for women and their carers, slides highlighting the key messages, costing tools and implementation advice. It includes key priorities for implementation and audit criteria.

Date of Publication: July 2006
Date of Endorsement: April 2008

Full guideline (PDF, 1.03MB, 393 Pages)
NICE guideline (PDF, 323KB, 46 Pages)
 

Pressure ulcers (NICE)

Pressure ulcers are caused when an area of skin and/or the tissues below are damaged as a result of being placed under sufficient pressure or distortion to impair its blood supply. Typically they occur in a person confined to a bed or a chair most of the time by an illness; as a result they are sometimes referred to as 'bedsores', or 'pressure sores'.
 
This quality standard covers the prevention, assessment and management of pressure ulcers in all settings, including hospitals, care homes with and without nursing and people’s own homes. It covers people of all ages: neonates, infants, children, young people and adults (including older people).
 
The quality standard is expected to contribute to improvements in the following outcomes:
  • incidence of category 2 pressure ulcers
  • incidence of category 3 pressure ulcers
  • incidence of category 4 pressure ulcers
  • health-related quality of life
  • length of hospital stay
  • discharge destination 
Date of Publication: June 2015
Endorsed on: July 2015
 
Full quality standard (PDF, 228KB, 54 Pages)
 

Pressure ulcers: prevention and management of pressure ulcers (NICE)

Pressure ulcers are caused when an area of skin and the tissues below are damaged as a result of being placed under pressure sufficient to impair its blood supply. Typically they occur in a person confined to bed or a chair by an illness and as a result they are sometimes referred to as 'bedsores', or 'pressure sores'.
 
This guideline offers best practice advice on the care of people with pressure ulcers. 
 
Date of Publication: April 2014
Endorsed on: October 2015
 
Full Guideline (PDF, 233KB, 38 Pages) 
 

Screening and Treatment of Retinopathy of Prematurity (RCPCH)

This evidence-based guideline for the screening and treatment of ROP was developed by the RCPCH in collaboration with the Royal College of Ophthalmologists, British Association of Perinatal Medicine and the premature baby charity BLISS.

The guideline is accompanied by an executive summary, screening examination record sheet, and parent leaflets for screening and for treatment. It includes key recommendations for implementation and audit standards.

Date of Publication: May 2008
Date of Endorsement: May 2008

Further information can be found here
 

The diagnosis of death by neurological criteria (DNC) in infants less than two months old (RCPCH)

This report provides recommendations on the diagnosis of death by neurological criteria (DNC) in infants from 37 weeks corrected gestation (post menstrual) to two months (post term) of age.
 
By request of the Academy of Medical Royal Colleges (AoMRC), the RCPCH has updated the report, Diagnosis of brain stem death in infants and children: a working party report by the British Paediatric Association, which was published in 1991 by the British Paediatric Association (currently RCPCH).
 
This report is aimed at UK paediatric and neonatal healthcare staff working with infants under two months of age. They are not applicable to pre term infants less than 37 weeks corrected gestation (post menstrual) age or infants older than two months post term. 
 
For infants older than two months the 2008 AoMRC ‘A Code of Practice for the Diagnosis and Confirmation of Death’ recommendations continue to apply.
 
Date of Publication: April 2015
Date of Endorsement: March 2015
 

Urinary Tract Infection in Children (NICE)

The guideline covers the investigations and treatment for children younger than 16 years who have a urinary tract infection (UTI) and the information that should be offered to their families. Urine testing strategies are provided. The guideline is particularly relevant to all healthcare professionals who are involved in providing care for children who have a UTI, those responsible for commissioning and planning healthcare services and children who have a UTI and their families.

The guideline includes key priorities for implementation, a quick reference guide, information for parents/carers, slides highlighting the key messages, audit criteria, costing tools, implementation advice, and an online educational tool.

Date of Publication: August 2007
Date of Endorsement: March 2008

Full guideline (PDF, 5.56MB, 178 Pages)
NICE guideline (PDF, 252KB, 30 Pages)