Newborn babies receiving antibiotics in hospital could be switched to oral antibiotics and cared for at home, the National Institute for Health and Care Excellence (NICE) has recommended in updated guidance.
The move could enable mothers whose babies need antibiotics to leave hospital sooner – potentially reducing their hospital stay by up to 2.7 days, NICE said.
The updated neonatal infection guidance makes clear that babies who are sent home and moved onto oral antibiotics would be monitored by hospital neonatal teams until treatment is complete ‘for safety reasons’ and ‘continuity of care’.
It also explained that this was applicable to babies that were ‘doing well and responding to treatment’.
Newborns are assessed for specific birth related risk factors, including premature birth before 37 weeks or if the mother had group b strep or sepsis during labour. The presence of risk factors prompts an immediate clinical assessment, and intravenous antibiotics are given when necessary.
While some of these babies will need to stay in hospital, the updated NICE guidance says babies born after 35 weeks can be switched to liquid antibiotics and taken home if they test negative for infection and are stable, feeding well and responding to treatment.
The approach has been successfully piloted in three projects across nine NHS sites in England. One such project, which was named NOAH and took place in Devon, showed an average hospital stay of 2.7 days per baby and estimated that up to 12,000 babies could benefit from the change per year if it was rolled out nationally.
This would bring ‘significant benefits’ to the NHS, including freeing up neonatal beds for babies who need intensive care and easing pressure on the busiest specialist wards, NICE said.
‘An important step forward’
Dr Tim Watts, guideline committee member and consultant neonatologist at Evelina London Children's Hospital, commented: ‘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.’
NICE’s clinical advisor for nursing Lucy Common added: ‘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 two follow-up consultations after discharge to check on the baby’s progress.’
The guidance also noted that clinicians should be aware of evidence showing that the longer the time is between the mother’s waters breaking and birth, the higher the risk of infection for the baby. This is regardless of whether the waters break before active labour or not.