Neonatal infections in England: the NeonIN surveillance network

Arch Dis Child Fetal Neonatal Ed. 2011 Jan;96(1):F9-F14. doi: 10.1136/adc.2009.178798. Epub 2010 Sep 27.


Introduction: Neonatal infection is an important cause of morbidity and mortality. Neonatal infection surveillance networks are necessary for defining the epidemiology of infections and monitoring changes over time.

Design: Prospective multicentre surveillance using a web-based database.

Setting: 12 English neonatal units.

Participants: Newborns admitted in 2006-2008, with positive blood, cerebrospinal fluid or urine culture and treated with antibiotics for at least 5 days.

Outcome measure: Incidence, age at infection, pathogens and antibiotic resistance profiles.

Results: With the inclusion of coagulase negative Staphylococci (CoNS), the incidence of all neonatal infection was 8/1000 live births and 71/1000 neonatal admissions (2007-2008). The majority of infections occurred in premature (<37 weeks) and low birthweight (<2500 g) infants (82% and 81%, respectively). The incidence of early onset sepsis (EOS; ≤48 h of age) was 0.9/1000 live births and 9/1000 neonatal admissions, and group B Streptococcus (58%) and Escherichia coli (18%) were the most common organisms. The incidence of late onset sepsis (LOS; >48 h of age) was 3/1000 live births and 29/1000 neonatal admissions (7/1000 live births and 61/1000 admissions including CoNS) and the most common organisms were CoNS (54%), Enterobacteriaceae (21%) and Staphylococcus aureus (18%, 11% of which were methicillin resistant S aureus). Fungi accounted for 9% of LOS (72% Candida albicans). The majority of pathogens causing EOS (95%) and LOS (84%) were susceptible to commonly used empiric first line antibiotic combinations of penicillin/gentamicin and flucloxacillin/gentamicin, respectively (excluding CoNS).

Conclusions: The authors have established NeonIN in England and defined the current epidemiology of neonatal infections. These data can be used for benchmarking among units, international comparisons and as a platform for interventional studies.

MeSH terms

  • Age of Onset
  • Anti-Bacterial Agents / therapeutic use
  • Bacterial Infections / drug therapy
  • Bacterial Infections / epidemiology
  • Bacterial Infections / microbiology
  • Drug Resistance, Microbial
  • England / epidemiology
  • Female
  • Humans
  • Incidence
  • Infant, Low Birth Weight
  • Infant, Newborn
  • Infant, Premature
  • Infant, Premature, Diseases / epidemiology
  • Infant, Premature, Diseases / microbiology
  • Intensive Care Units, Neonatal / statistics & numerical data*
  • Male
  • Mycoses / drug therapy
  • Mycoses / epidemiology
  • Mycoses / microbiology
  • Population Surveillance
  • Sepsis / drug therapy
  • Sepsis / epidemiology*
  • Sepsis / microbiology


  • Anti-Bacterial Agents