Neonatal Surgery Antimicrobial Prophylaxis

Publication: 01/06/2010  
Last review: 29/01/2019  
Next review: 03/01/2022  
Clinical Guideline
CURRENT 
ID: 1809 
Approved By: Improving Antimicrobial Prescribing Group 
Copyright© Leeds Teaching Hospitals NHS Trust 2019  

 

This Clinical Guideline is intended for use by healthcare professionals within Leeds unless otherwise stated.
For healthcare professionals in other trusts, please ensure that you consult relevant local and national guidance.

Guideline for Antimicrobial Prophylaxis in Neonatal Surgery

Summary
Neonatal Surgery Antimicrobial Prophylaxis

Summary table of routine recommendations

It is the responsibility of the surgical team to prescribe the prophylactic antibiotics and to ensure that they have been given within one hour before incision.

Procedure

Antibiotic prophylaxis recommended?

Evidence level

Antimicrobial dose/route
Give less than 1 hours before starting procedure

Gastrointestinal Procedures

Routine

MRSA risk* or true penicillin allergy

Gastro duodenal surgery involving entry into the lumen of GI tract

Yes

C

IV gentamicin 5mg/kg as a single dose prescribed on emeds using neonatal gentamicin protocol

IV gentamicin 5mg/kg as a single dose prescribed on on emeds using neonatal gentamicin protocol

IV metronidazole electronic Medicines Compendium information on Metronidazole

Neonate less than 26 weeks corrected gestational age:
15 mg/kg as a single loading dose followed after 24 hours by
7.5 mg/kg daily

Neonate 26–34 weeks corrected gestational age:
15 mg/kg as a single loading dose followed after 12 hours by
7.5 mg/kg every 12 hours

Neonate over 34 weeks corrected gestational age:
15 mg/kg as a single loading dose followed after 8 hours by
7.5 mg/kg every 8 hours

IV metronidazole electronic Medicines Compendium information on Metronidazole

Neonate less than 26 weeks corrected gestational age:
15 mg/kg as a single loading dose followed after 24 hours by
7.5 mg/kg daily

Neonate 26–34 weeks corrected gestational age:
15 mg/kg as a single loading dose followed after 12 hours by
7.5 mg/kg every 12 hours

Neonate over 34 weeks corrected gestational age:
15 mg/kg as a single loading dose followed after 8 hours by
7.5 mg/kg every 8 hours

Duration 24-48hours

Duration 24-48hours

Biliary tract procedures

Yes

C

IV amoxicillin electronic Medicines Compendium information on Amoxicillin

Neonate under 7 days of age:
30 mg/kg every 12 hours;

Neonate 7–28 days of age:
30 mg/kg every 8 hours

IV teicoplanin electronic Medicines Compendium information on Teicoplanin
Neonate: Initially 16 mg/kg for one dose followed 24 hours later by 8 mg/kg once daily (intravenous infusion only)

IV gentamicin 5mg/kg as a single dose prescribed on emeds using neonatal gentamicin protocol

IV gentamicin 5mg/kg as a single dose prescribed on emeds using neonatal gentamicin protocol

IV metronidazole electronic Medicines Compendium information on Metronidazole

Neonate less than 26 weeks corrected gestational age:
15 mg/kg as a single loading dose followed after 24 hours by
7.5 mg/kg daily

Neonate 26–34 weeks corrected gestational age:
15 mg/kg as a single loading dose followed after 12 hours by
7.5 mg/kg every 12 hours

Neonate over 34 weeks corrected gestational age:
15 mg/kg as a single loading dose followed after 8 hours by
7.5 mg/kg every 8 hours

IV metronidazole electronic Medicines Compendium information on Metronidazole

Neonate less than 26 weeks corrected gestational age:
15 mg/kg as a single loading dose followed after 24 hours by
7.5 mg/kg daily

Neonate 26–34 weeks corrected gestational age:
15 mg/kg as a single loading dose followed after 12 hours by
7.5 mg/kg every 12 hours

Neonate over 34 weeks corrected gestational age:
15 mg/kg as a single loading dose followed after 8 hours by
7.5 mg/kg every 8 hours

Duration 24-48hours

Duration 24-48hours

Colorectal surgery

Yes

C

IV amoxicillin electronic Medicines Compendium information on Amoxicillin

Neonate under 7 days of age:
30 mg/kg every 12 hours;

Neonate 7–28 days of age:
30 mg/kg every 8 hours

IV teicoplanin electronic Medicines Compendium information on Teicoplanin
Neonate: Initially 16 mg/kg for one dose followed 24 hours later by 8 mg/kg once daily (intravenous infusion only)

IV gentamicin 5mg/kg as a single dose prescribed on emeds using neonatal gentamicin protocol

IV gentamicin 5mg/kg as a single dose prescribed on emeds using neonatal gentamicin protocol

IV metronidazole electronic Medicines Compendium information on Metronidazole

Neonate less than 26 weeks corrected gestational age:
15 mg/kg as a single loading dose followed after 24 hours by
7.5 mg/kg daily

Neonate 26–34 weeks corrected gestational age:
15 mg/kg as a single loading dose followed after 12 hours by
7.5 mg/kg every 12 hours

Neonate over 34 weeks corrected gestational age:
15 mg/kg as a single loading dose followed after 8 hours by
7.5 mg/kg every 8 hours

IV metronidazole electronic Medicines Compendium information on Metronidazole

Neonate less than 26 weeks corrected gestational age:
15 mg/kg as a single loading dose followed after 24 hours by
7.5 mg/kg daily

Neonate 26–34 weeks corrected gestational age:
15 mg/kg as a single loading dose followed after 12 hours by
7.5 mg/kg every 12 hours

Neonate over 34 weeks corrected gestational age:
15 mg/kg as a single loading dose followed after 8 hours by
7.5 mg/kg every 8 hours

Duration 24-48hours

Duration 24-48hours

Non Cardiac thoracic Procedures

Routine

MRSA risk* or true penicillin allergy

Oesophageal atresia
See also separate guidelines

Antibiotic prophylaxis recommended

C

IV amoxicillin electronic Medicines Compendium information on Amoxicillin
Neonate under 7 days of age:
30 mg/kg every 12 hours;
Neonate 7–28 days of age:
30 mg/kg every 8 hours

IV teicoplanin electronic Medicines Compendium information on Teicoplanin
Neonate: Initially 16 mg/kg for one dose followed 24 hours later by 8 mg/kg once daily (intravenous infusion only)

IV metronidazole electronic Medicines Compendium information on Metronidazole

Neonate less than 26 weeks corrected gestational age:
15 mg/kg as a single loading dose followed after 24 hours by
7.5 mg/kg daily

Neonate 26–34 weeks corrected gestational age:
15 mg/kg as a single loading dose followed after 12 hours by
7.5 mg/kg every 12 hours

Neonate over 34 weeks corrected gestational age:
15 mg/kg as a single loading dose followed after 8 hours by
7.5 mg/kg every 8 hours

IV metronidazole electronic Medicines Compendium information on Metronidazole

Neonate less than 26 weeks corrected gestational age:
15 mg/kg as a single loading dose followed after 24 hours by
7.5 mg/kg daily

Neonate 26–34 weeks corrected gestational age:
15 mg/kg as a single loading dose followed after 12 hours by
7.5 mg/kg every 12 hours

Neonate over 34 weeks corrected gestational age:
15 mg/kg as a single loading dose followed after 8 hours by
7.5 mg/kg every 8 hours

IV gentamicin 5mg/kg as a single dose prescribed on emeds using neonatal gentamicin protocol

IV gentamicin 5mg/kg as a single dose prescribed on emeds using neonatal gentamicin protocol

Duration 24-48 hours

Duration 24-48 hours

Lung resection
See also separate guidelines

 

 

IV amoxicillin electronic Medicines Compendium information on Amoxicillin
Neonate all ages:
30 mg/kg single dose

IV teicoplanin electronic Medicines Compendium information on Teicoplanin
Neonate: single dose of 16 mg/kg

IV gentamicin 5mg/kg
Single dose

IV gentamicin 5mg/kg
Single dose

Oesophagoscopy, thoracoscopy, bronchoscopy

Not recommended

 

 

 

Neurosurgery

Yes

 

IV flucloxacillin
 Neonate all ages:
25 mg/kg single dose

IV teicoplanin electronic Medicines Compendium information on Teicoplanin
Neonate: single dose of 16 mg/kg

IV gentamicin 5mg/kg as a single dose prescribed on emeds using neonatal gentamicin protocol

IV gentamicin 5mg/kg as a single dose prescribed on emeds using neonatal gentamicin protocol

Non Cardiac thoracic Procedures

Routine

MRSA risk* or true penicillin allergy

Cardiovascular surgery

Refer to guidelines on LHP

*MRSA risk = previous or current MRSA infection or colonisation
** Duration of prophylaxis may need to be reviewed in individual cases, please contact Microbiology.
Please see BNFc and neonatal unit gentamicin policy for doses if longer than 24 hours prophylaxis is required
Guidelines are for “clean” or “clean/contaminated” cases. For contaminated cases, there may be a need to consider changing prophylaxis to treatment. This should be documented in clinical and operative notes. Please note that the use of antibiotic therapy in acute NEC also constitutes treatment and therefore falls outside the remit of this document.

Please Discuss with Microbiology for individual cases if any risk factors for or previous colonisation with antimicrobial resistant organisms

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Background

Perioperative prophylaxis for prevention of postoperative infections has been one of the major indications of antimicrobials infections in neonates and children. Two studies have demonstrated that approximately 75% of antimicrobial use in paediatric surgical services is for prophylaxis.

Prophylactic antibiotics have been shown to be effective in reducing post-operative infections in clean- contaminated and contaminated procedures whereas their efficacy remains controversial for clean surgical procedures. Studies documenting that systemic antimicrobial prophylaxis decrease the incidence of surgical site infections have been primarily performed in adults. As the pathogenesis of wound infections does not differ in any age groups, the guidelines have been extended for neonatal and paediatric use with recommendations for short duration of prophylaxis up to 24hours.

Prophylaxis is recommended for most gastrointestinal procedures. The number of organisms and proportion of anaerobic organisms progressively increase along the gastrointestinal tract, so the recommendation depends on the segment of gastrointestinal tract entered during the procedure. Colorectal procedures have a very high intrinsic risk of infection and warrant a strong recommendation for prophylaxis with antibiotics directed at gram negative bacteria and anaerobic organisms.

A small number of clinical trials support the use of perioperative antibiotics in non-cardiac thoracic surgery in adults with a decrease in surgical site infection post- operatively, however, there is no consistent data to demonstrate an effect of peri-operative antibiotics on the rate of postoperative pneumonia or empyema.

A single dose of prophylactic antibiotics which provides adequate tissue concentration throughout the procedure has been recommended for adults. Studies have shown that the administration of prophylactic antibiotics after wound closure does not reduce infection rates further and can result in harm. This may need to be reviewed in some vulnerable neonates, especially following closure of anterior abdominal wall; however duration of prophylaxis should not exceed 48hours and may need Discussion with Microbiology.
Re-administration of antibiotics for surgical site infection prophylaxis is based on the antibiotic selected and the length of the surgical procedure. In procedures lasting more than four hours or when major blood loss occurs (25ml/kg), re-dosing should occur (in patients with normal renal function) so that the bactericidal concentrations are maintained in the tissues while the incision remains open. This is not applicable for gentamicin where doses should not be repeated.

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Provenance

Record: 1809
Objective:
Clinical condition:

Antimicrobial prophylaxis in neonates

Target patient group: All neonates undergoing surgical procedures
Target professional group(s): Secondary Care Doctors
Secondary Care Nurses
Pharmacists
Adapted from:

Evidence base

 

References

  1. SIGN. Antibiotic Prophylaxis in Surgery. Scottish Intercollegiate Guideline Network Publication Number 104. Edinburgh; 2008
  2. Fonseca SNS, Melon SR, Junqueira MJ, et al. Implementing 1-dose antibiotic prophylaxis for prevention of surgical site infection. Arch Surg 2006;141:1109-13
  3. BNFc December 2015 update accessed via www.medicinescomplete.com

Evidence level (A,B,C, D)

A. Meta-analyses, randomised controlled trials/systematic reviews of RCTs
B. Robust experimental or observational studies
C. Expert consensus.
D. LTHT Consensus (no national guidelines exist, guidelines from different learned bodies contradict each other, or no evidence exists)

 

Approved By

Improving Antimicrobial Prescribing Group

Document history

LHP version 1.0

Related information

Not supplied

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