• No persistent physiological abnormalities 

Any one of the following persisting ≥4 hr after birth^* 

• Tachycardia (HR ≥160 bpm) 
• Tachypnoea (RR ≥60) 
• Temperature <36.5°C or ≥38°C 
• Respiratory distress (grunting, nasal flaring or chest recessions) not requiring supplemental oxygen 

≥2 of the following lasting ≥2 hr ^†

• Tachycardia (HR ≥160 bpm) 
• Tachypnoea (RR ≥60) 
• Temperature <36.5°C or ≥38°C
• Respiratory distress (grunting, nasal flaring or chest recessions) not requiring supplemental oxygen 

* Abnormalities can be intermittent
† If any observations abnormal for 2 consecutive hours – arrange
middle grade review and consider commencing antibiotics 

• Persistent need for CPAP/HFNC/mechanical ventilation (outside of the delivery room) 
• Haemodynamic instability requiring fluid bolus or inotropes
• Neonatal encephalopathy/perinatal depression 
  • seizure 
  • Apgar score <5 at 5 min 
• Need for supplemental oxygen ≥2 hr to maintain SpO₂ >90%
• Any other symptoms of serious illness – clinician determined 
• Following should also be classified as clinical illness
  • equivocal state persisting >2 hr
  • onset of symptoms at >4 hr after an asymptomatic period 

Incidence of early-onset sepsis 

Weeks range: 34–43 

Days range: 0–6 

Highest maternal intrapartum temperature (°C) 

Units °Celsius 

Use highest intrapartum maternal temperature including up to 1 hr following delivery 

Use whole number or number with single decimal place  e.g.: 37, 37.1, 37.0 

NOTE: If postpartum temperature within 1 hr of birth is ≥0.5°C above intrapartum temperature, midwives to document and inform neonatal team

Round value to single decimal place, e.g. enter ROM 4 hr 30 min as 4.5 hr, 4 hr 55 min as 5.0 hr 

Type of intrapartum antibiotics 

• 'GBS-specific antibiotics' are defined ONLY as penicillin G, ampicillin is an acceptable alternative. Penicillin-allergic women with no history of anaphylaxis, angioedema, respiratory distress, or urticaria after administration of penicillin or a cephalosporin should receive cefuroxime
  • should apply only to mothers who are GBS positive or GBS unknown

and

• If erythromycin, clindamycin or vancomycin ALONE are given for GBS prophylaxis, choose the option 'No antibiotics or any antibiotics given <2 hr prior to delivery'
  
• 'Broad-spectrum antibiotics (BSAB)' defined as ≥2 antibiotics given in combination when concern for the mother developing chorioamnionitis

Interval from first dose to birth 

• 'Timing' of administration of 'GBS-specific antibiotics' or 'BSAB administration' = interval between first dose of penicillin G or second antibiotic in the combination to the time of birth
• e.g.: cefuroxime at 2:00 pm, metronidazole at 3:30 pm, birth at 4:30 pm, so 2^nd antibiotic given 1 hr before delivery. Choose 'No antibiotics or any antibiotics given <2 hours prior to delivery'
• If mother given BOTH GBS-specific antibiotics and BSAB – of the 4 possible options, select the category with the longest duration of treatment
  • e.g.: penicillin G at 8:00 pm and 12:00 pm for GBS positive, then develops fever to 38.3°C at 2:00 pm so cefuroxime given at 3:00 pm. Penicillin G given at 4:00 pm, birth at 4:30 pm. GBS-specific antibiotics were given >4 hr before delivery, but BSAB were given only 1.5 hr before delivery. Choose 'GBS specific antibiotics given >2 hours prior to birth'

• Routine observations at aged 1 hr and aged 2 hr, then
• 2-hrly until aged 12 hr, then
• 4-hrly until aged 36 hr (despite KP-SRC recommending only 24 hr in some)

• Hourly until all observations in normal range for 2 consecutive measurements. Then follow guidance for well appearing baby
• If any 2 consecutive measurements abnormal or equivocal request middle grade assessment and review need for antibiotics

• Admit to NICU and observation as directed by clinician