Innovative antibiotics pathway reduces hospital stays for newborns
A pioneering neonatal pathway is helping to transform how suspected early-onset infections (EOI) in newborns are managed — helping families go home sooner while easing pressure on hospitals.
The Neonatal Oral Antibiotics at Home (NOAH) approach allows eligible newborns with suspected EOI to safely continue their antibiotic treatment at home after 36 hours of hospital care, switching from intravenous to oral antibiotics.
Following a successful six-month pilot at the Royal Devon University Healthcare NHS Foundation (RDUH), NOAH is now embedded in routine practice. The results have been striking:
- 2.7 hospital days saved per baby, on average
- £66.5k in potential annual cost savings for the Trust
- Reduction in antibiotic exposure, with gentamicin doses falling from 3 to 1.7 per baby
- 97% of staff reported positive impacts for babies, families, and the hospital
- Estimated 8,230kg of CO₂ emissions avoided annually, supporting NHS Net Zero goals
The pilot took place at the Royal Devon and Exeter (Wonford) Hospital site of the RDUH and involved 27 families being discharged onto the new pathway. One parent involved in the pilot shared: “We were incredibly happy and relieved to be able to take our baby home. Recovery and bonding worked so much better in our own space.”
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.
A full evaluation conducted by Health Innovation South West confirmed the effectiveness and acceptability of implementing NOAH within the neonatal patient pathway in the UK. Implementation resources have now been developed to support other regional and national neonatal teams looking to adopt this quality improvement initiative.
Prof Stuart Logan, Director NIHR ARC South West Peninsular, said: “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.”
Further regional evaluation is planned for 2025/26 to assess the broader impact and refine the model for wider adoption.
For further information, background to the project and sample resources click here. Teams should be advised to follow their local governance processes and decision making before they implement NOAH.
