Neonatal infection guidance updated to allow home antibiotic treatment for some babies
We’ve recommended that newborn babies receiving antibiotics in hospital could potentially switch to oral antibiotics and be cared for at home if they are doing well and responding to treatment.
This means mothers whose babies need antibiotics could leave hospital sooner and complete treatment at home with full clinical support, potentially reducing their hospital stay by up to 2.7 days.
All newborns are assessed for specific birth related risk factors, including premature birth before 37 weeks and if the mother tests positive for group b strep or is thought to have sepsis during labour. Where risk factors are identified, a full clinical assessment is done immediately and if needed, the baby is given antibiotics intravenously through a line in the vein.
Some of these babies will need to stay in hospital. But our new guidance says babies born after 35 weeks who are on intravenous antibiotics can be switched to a simple liquid oral antibiotic and taken home to complete the course if they test negative for infection, are stable, feeding well, and responding as expected to treatment.
The safety of this approach has been piloted successfully in 3 projects across 9 NHS sites in England, and the evidence shows that babies who complete their antibiotic course at home do just as well as those who remain in hospital.
This also brings significant benefits for the NHS. Evidence from the NOAH Project, a pilot in Devon, showed that the average hospital stay reduced by 2.7 days per baby under this approach. The NOAH project estimated that up to12,000 babies a year in England could benefit from the change if rolled out nationally.
Shorter stays free up neonatal unit beds for babies who need the most intensive care, easing pressure on some of the busiest specialist wards in the country.
Eric Power, interim director, NICE centre for guidelines said: “These updated recommendations will improve how some mothers experience the first few days with their new baby.
"We know the first days with a new baby can be overwhelming, especially if your baby is being treated for a suspected infection.
This update means families whose babies are well and responding to treatment can settle at home in familiar surroundings, give their baby their medication with confidence, and still have the full support of their neonatal team every step of the way.
Lucy Common, NICE’s clinical advisor for nursing said: “As part of our updated guideline, we specify parents are trained by the neonatal team in how to give their baby antibiotics orally, recommending this must be done under clinical supervision in hospital before they can go home.
“Crucially, this support continues and we recommend at least 2 follow-up consultations after discharge to check on the baby's progress.”
Dr Tim Watts, guideline committee member and Consultant Neonatologist at the Evelina said: “Rolling this out nationally would mark an important step forward both for families and the NHS. We have seen that babies can complete their antibiotic course just as safely at home as in hospital and that many families prefer settling their new babies in at home.
“This move would also free up neonatal transitional care and postnatal beds, meaning we can focus our care towards the mothers and babies who truly need to stay in hospital.”
Emily Rose Jeffrey, mother to Luna took part in the NOAH trial, said: “We had a successful homebirth, but we transferred postnatally after Luna had meconium in her waters. After an initial test it was found that Luna had an infection and needed to remain in hospital under the care of neonatal team. This made me feel extremely overwhelmed and nervous at a time of huge change.
“After a couple of days, Luna was responding well to treatment and we were told there was a possibility we could go home and administer the rest of her treatment there. Luna was kept under close observation and it was only when it was obvious that her infection levels were dropping drastically that we were told I’d be able to administer antibiotics at home.
The follow-up care was also incredible once we were home, with phone call check-ins. In being able to come home, which we’d originally planned, it allowed us to create lovely early memories together, and I’m forever thankful for the NOAH project for gifting us that valuable time, something we’d never have been able to get back.
The independent committee also reviewed evidence for how clinicians assess the risk posed by a mother's waters breaking before birth. The evidence showed that the longer the time is between the mother’s waters breaking and birth, the higher the risk of infection for the baby. The guidance now clarifies it is the total time between the waters breaking and the baby being born, regardless of whether waters break before active labour or not that is most important when assessing a baby's risk of infection.