OSCE stationSP stationEarly-onset sepsis
A communication station: explaining to a worried parent why a well baby with one risk factor is being monitored rather than given antibiotics.
You are the paediatric registrar on the postnatal ward. Baby Layla was born at 39 weeks, 3 hours ago. Her mother had group B streptococcus (GBS) identified on a swab in this pregnancy. There are no other risk factors, and Layla is well on examination.
Your consultant has agreed that, under NICE NG195, Layla will be monitored rather than started on antibiotics. Her father has asked to speak to a doctor. Explain the plan and answer his questions.
Suggested time: 9 minutes
You are Omar, Layla's father. You are worried and a little frustrated: your sister's baby had "an infection after birth" and needed antibiotics. Settle if the doctor explains clearly and takes your worry seriously; push back once if they use jargon.
Opening line: “The midwife said my wife carries a bacteria. Why isn't my daughter getting antibiotics?”
Questions to raise if the candidate doesn’t cover them:
- Isn't it safer just to give antibiotics anyway?
- What exactly are you watching for?
- How long will she be watched?
- What happens if she does become unwell?
Questions
Why isn't Layla being given antibiotics?
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- She has one risk factor (maternal GBS colonisation in this pregnancy), no red flags and no signs of infection.
- For a baby with no red flags and only one risk factor, NICE asks doctors to use clinical judgement on whether it is safe to hold off antibiotics.
Isn't it safer just to give antibiotics anyway?
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- Most babies with a risk factor are not infected; in well-appearing term babies with risk factors, the chance of infection is very low (about 1% in the CPS statement).
- The aim is to spare well babies unnecessary antibiotics while treating promptly any baby who becomes unwell.
What exactly are you watching for?
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- Changes in behaviour or responsiveness, floppiness, feeding difficulties or vomiting.
- Breathing difficulty (grunting, fast breathing), pauses in breathing, an abnormal heart rate, or a temperature below 36 °C or above 38 °C not explained by the environment.
- Fits, or colour change suggesting low oxygen.
How long will she be watched?
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- If monitoring is needed, NICE says it continues for at least 12 hours, using a newborn early warning system.
What happens if she does become unwell?
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- She would be assessed straight away, and if she needs antibiotics they are given as soon as possible and always within 1 hour of the decision to treat.
- Safety-net: tell staff at once about any of the warning signs.
Based on: NICE guideline NG195, Neonatal infection: antibiotics for prevention and treatment (2021, last updated May 2026). Canadian Paediatric Society, Management of term infants at increased risk for early onset bacterial sepsis (2017).
Tiny Taught · Neonatal & Paediatric Education
Teaching material for exam preparation. Doses and thresholds are for orientation only; follow your local guidelines.