Neonatal Oral Antibiotics at Home (NOAH)
Enabling eligible newborns with suspected early onset infection to go home earlier on oral antibiotics.
Impact
- 2.7 hospital days saved per baby (on average) by introducing NOAH
- £66.5k potential annual cost saving for the Trust by reducing hospital stays, medication, and the use of associated equipment.
- Reduction from 3 to 1.7 in the average number of doses of gentamicin per baby.
- 97% of staff felt that the NOAH pathway has a positive impact on babies, families, and the hospital.
- 8,230kg CO2 estimated saving when implementing NOAH for one year.
Project summary
Neonatal Oral Antibiotics at Home (NOAH) allows eligible newborns with suspected early-onset infection (EOI) to switch from intravenous antibiotics in the hospital to oral antibiotics at home after 36 hours of treatment.
This innovative approach reduces hospital stays, improves family experiences, minimises potential risk from gentamicin exposure, lowers costs to the NHS, and optimises workforce capacity.
A six-month pilot at the Royal Devon and Exeter (Wonford) Hospital site of the Royal Devon University Healthcare NHS Foundation Trust introduced the NOAH pathway. Through the period of the pilot, 27 families were discharged onto the new pathway.
Following the pilot a comprehensive evaluation was conducted by Health Innovation South West. The pilot was a success, resulting in baby and parent avoiding an average of 2.7 days of hospital stay and an annual cost avoidance of around £65,540. More importantly, this represents beds that are free, and staff that are available for more babies who need support.
NOAH has now been integrated into standard practice at the Royal Devon University Healthcare NHS Foundation Trust.
Rationale
In the UK, standard management of suspected EOI involves a minimum of 36 hours of IV antibiotics. When there are ongoing concerns about infection, IV antibiotics are continued for up to seven days.
Allowing eligible newborns with suspected EOI to switch from IV antibiotics in the hospital to oral antibiotics at home after 36 hours of treatment addresses critical challenges in rural areas like Devon, where many families face long journeys to reach neonatal services.
More people in Devon live further from a neonatal unit than average in England and few live within 50km of more than one unit. There are a limited number of beds across the neonatal network in the South West, with very few trusts operating Neonatal Intensive Care Units. Optimal management of bed capacity across the network is vital for families to avoid travelling potentially hundreds of miles to the next closest unit with availability.
Key stakeholders
- Health Innovation South West conducted a comprehensive evaluation of the pilot to establish the efficacy, acceptability and feasibility of implementing the NOAH pathway within the neonatal patient pathway in the UK. We also created regional implementation resources and engaged with regional stakeholders to support ease of spread.
- Royal Devon University Healthcare NHS Foundation Trust (Exeter site) were responsible for setting up and running the clinical pilot.
- South West Neonatal Network are supporting the spread of the project across the region, for those who wish to implement.
- NIHR Applied Research Collaboration South West Peninsula supported the evidence review to underpin the pilot and helped design the implementation and evaluation plan. In 2025/26 they are funding a knowledge mobilisation fellow/s to support NOAH spread and a further South West evaluation around implementation. Fellows act as a bridge between research, evidence, and practice, helping to create the conditions for the right people to access the right information at the right time.
Next steps
For neonatal teams wishing to adopt this quality improvement initiative, a range of implementation resources have been developed to help you plan, execute, and sustain NOAH. For more information click here. Teams should be advised to follow their local governance processes and decision making before they implement NOAH.
Further evaluation is planned for 2025/26 focused on regional implementation, scaled up benefits, and lessons learned. Some national uptake is also expected.
These changes mean large numbers of newborn babies spending less time in hospital which is great for families and reduces the pressure on neonatal units. It is a fantastic example of brilliant clinicians producing and using evidence which can improve the lives of newborn babies. I’m delighted that Health Innovation South West and NIHR PenARC have been able to help with this work and will now work with the team to spread this change across the country.
Prof Stuart Logan, Director NIHR ARC South West Peninsula
