Antibiotics are increasingly prescribed in the peripartum period, for both maternal and fetal indications. Their effective use undoubtedly reduces the incidence of specific invasive infections in the newborn, such as group B streptococcal septicaemia. However, the total burden of infectious neonatal disease may not be reduced, particularly if broad‐spectrum agents are used, as the pattern of infections has been shown to alter to allow dominance of previously uncommon organisms. This area has been relatively understudied, and there are almost no studies of long‐term outcome. Recent findings suggest that such long‐term data should be sought. First, there is evidence that organisms initially colonising the gut at birth may establish chronic persistence in many children, in contrast to prompt clearance if first encountered in later infancy, childhood or adulthood. Second, there is a rapidly advancing basic scientific data showing that individual members of the gut flora specifically induce gene activation within the host, modulating mucosal and systemic immune function and having an additional impact on metabolic programming. We thus review the published data on the impact of perinatal antibiotic regimens upon composition of the flora and later health outcomes in young children and summarise the recent scientific findings on the potential importance of gut flora composition on immune tolerance and metabolism.

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Background One of the aims of managed newborn clinical networks is to monitor and report on their neonatal mortality as an outcome measures of improvements in quality of care. The South West Midlands Newborn Network (SWMNN) was established in 2004. Badger electronic patient database has been used since 2009 across all SWMNN units. Aim To review the trends in neonatal mortality in neonatal units within a newborn clinical network. Methods Badger electronic patient database was used to collect the demographic details and cause of death between 01/4/09 and 31/03/13. Results In the last 4 years there is a decreasing trend in the overall mortality within neonatal units in the newborn clinical network as show in the table. Abstract PC.123 Table Categories – cause of death 09/10 10/11 11/12 12/13 Total number of admissions 4236 4514 4836 5429 Prematurity 13 14 8 12 Infection 22 5 6 6 HIE 17 12 12 6 Respiratory 12 4 19 16 IVH 8 5 3 5 NEC 7 12 5 6 Coroners 4 3 3 2 Congenital malformation 10 18 22 11 Chromosomal 0 4 2 1 Myopathy 0 3 0 1 Metabolic 1 1 3 1 Miscellaneous 2 2 3 5 Total 96 83 86 72 Conclusion The decreasing trend in mortality within neonatal units might reflect that the care these babies are receiving is improving and delivered in the appropriately designated neonatal units. There is also a reduction in infection as the primary cause of death over the last four years.

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