Early-onset neonatal bacterial infection (infection with onset within 72 hours of birth) is a significant cause of mortality and morbidity in newborn babies. Parent organisations and the scientific literature report that there can be unnecessary delays in recognising and treating sick babies. In addition, concern about the possibility of early-onset neonatal infection is common. This concern is an important influence on the care given to pregnant women and newborn babies. There is wide variation in how the risk of early-onset neonatal infection is managed in healthy babies. The approach taken by the NHS needs to: prioritise the treatment of sick babies, minimise the impact of management pathways on healthy women and babies, use antibiotics wisely to avoid the development of resistance to antibiotics. These drivers have not always been addressed consistently in the NHS, and this guideline was commissioned to ensure they would be addressed in future. Five key principles underpin the recommendations in this guideline. Unless it is dangerous, families should be offered choice. The guideline includes recommendations to support families in making choices through provision of information and, where appropriate, reassurance. Intrapartum antibiotic prophylaxis should be administered in a timely manner to all eligible women who choose it. Babies with suspected early-onset neonatal infection should be treated as quickly as possible. Antibiotic exposure should be minimised in babies who do not have an early-onset neonatal infection. An integrated system of clinical care is needed to allow full implementation of the guideline recommendations.