The NHS needs to prioritise the treatment of sick babies and administer antibiotics appropriately to reduce the risk of youngsters developing bacterial resistance, new NICE guidelines state.

The guidelines are part of a series of recommendations issued to the NHS to tackle early-onset neonatal bacterial infection in newborn babies.

Neonatal bacterial infection is a major cause of mortality and morbidity in newborns and causes the death of 1 in every 4 babies who develop it – despite antibiotics.

Professor Mark Baker, Director of the Centre for Clinical Practice at NICE, believes the new guideline “will be welcomed as a useful tool” for healthcare professionals.

Other recommendations included in the guidelines include:

• Using a framework based on risk factors and clinical indicators to identify and treat babies at risk
• Intrapartum antibiotic prophylaxis offered to women whose babies are at a higher risk of infection
• Babies suspected to be at risk should receive antibiotics within an hour of the decision to treat
• Benzylpenicillin and gentamicin should be used in combination as the first-choice antibiotic regimen
• A blood culture should be performed on babies before they are administered their first dose.

Mark Turner, Senior Lecturer and Consultant in Neonatology, University of Liverpool and Liverpool Women’s NHS Foundation Trust – who also chaired the guideline development group – said the NHS should prioritise treatment for sick babies and ensure the correct antibiotics are used “sensibly”.

A new guideline to improve the management and mortality rate of acute upper gastrointestinal (GI) bleeding has been published by NICE.

It includes key recommendations such as the continued use of low-dose aspirin for secondary prevention of vascular events and patients with severe GI bleeding being offered endoscopy immediately after resuscitation.

Despite changes in the management of the condition, mortality rates have not improved in half a century with around 5,000 deaths per year in the UK recorded.

Professor Mark Baker, Director of the Centre for Clinical Practice at NICE, hoped the guideline would be a “useful aid to all healthcare professionals”.

Bleeding in the oesophagus, stomach or duodenum is the most common emergency managed by gastroenterologists in the UK – resulting in 50,000 hospital admissions annually.

It is estimated that around 1 in 10 admissions for upper GI bleeding end in the patient’s death.

The new guideline also recommends endoscopy being offered within 24 hours of admission to all other patients with upper GI bleeding and interventional radiology to unstable patients who re-bleed after endoscopic treatment.

“Although there have been changes in how upper gastrointestinal tract bleeding is managed, mortality has not improved much over the past 50 years and thousands of people still die from the condition every year,” said Professor Baker.

“We are, therefore, pleased to be publishing this guideline on the management of acute upper gastrointestinal bleeding.”

Risk assessment, resuscitation and initial management, timing of endoscopy, controlling bleeding and preventing re-bleeding, plus information and support for patients and carers are also addressed within the guideline.

The European Commission has granted approval for two new indications in the UK for Bayer HealthCare’s Xarelto (rivaroxaban).

The oral anticoagulant has been approved for the prevention of stroke and non-CNS systemic embolism in adults with non-valvular atrial fibrillation (AF) and one or more risk factors for stroke and for the treatment of deep vein thrombosis (DVT).

AF, the most common sustained cardiac rhythm disorder, affects around 750,000 people in the UK. In England each year, more than 25,000 people die from DVT contracted in hospital.

Xarelto is already indicated in the UK to help prevent VTE in patients undergoing elective total hip or knee replacement surgery. It’s believed to have been used in more than 100,000 patients in the UK and has treated more than a million patients worldwide for this indication.

The latest indication for the prevention of stroke and non-CNS systemic embolism was based on the results from ROCKET AF trial which demonstrated consistent findings.

NICE Guidelines recommend oral anticoagulants for the majority of AF patients to prevent stroke. However, current treatment options, such as warfarin, have limitations that challenge both healthcare professionals and patients. It is subject to potential limitations including unpredictable anticoagulant effects and can interact with numerous drugs and a wide array of food and drink in certain patients.

Xarelto is the first in a class of non-VKA anticoagulants called Factor Xa inhibitors. It offers a convenient oral dosing and a lower risk of interactions with other drugs compared with VKA antagonists, such as warfarin.

“Treatments which act at a key point in the blood-clotting process are now emerging as an important therapy option in both short and long-term clinical settings, and have the potential to help re-shape clinical practice,” said Professor Keith Fox, Professor of Cardiology at the University of Edinburgh.