Neonatal Oral Antibiotics at Home (NOAH)

Antibiotics are one of the most commonly used medicines for newborn babies, especially in the first few weeks of life when doctors are watching closely for possible infections. Infections that appear within the first 72 hours after birth — called early-onset infections — are treated very seriously. To be safe, doctors usually start babies on antibiotics through a drip (called intravenous or IV antibiotics) for at least 36 hours.

In most cases, if tests and observations show no signs of infection, the antibiotics are stopped after 36 to 48 hours. But it’s not always easy to tell if a baby is truly infected, since early symptoms can be vague. About 25–30% of babies who start on antibiotics end up needing a longer course — usually 5 to 7 days — because doctors can’t be sure there’s no infection.

At the Royal Devon University Healthcare NHS Foundation Trust, a new approach is being introduced. If a baby needs a longer course of antibiotics, parents may be offered the option to switch from IV antibiotics to antibiotic medicine taken by mouth (oral antibiotics) after 36 hours — as long as the baby meets certain safety criteria. This switch could bring some important benefits, like helping babies go home from the hospital sooner.

What is this project doing?

There are two main parts to our work:

1. Our Evidence Synthesis Team is reviewing all the existing research to better understand the effects of switching from intravenous (IV) to oral antibiotics in newborns with suspected early infections.

2. We’re working with clinical teams at the Royal Devon University Healthcare NHS Foundation Trust and Health Innovation South West to share the NOAH pathway more widely across the South West and assess how well it can be adopted elsewhere.

The research review will explore the impact of switching to oral antibiotics on babies’ health, family experiences, and healthcare costs. It will also look at the views of healthcare staff, parents, and families on this approach.

Since this practice is not yet common, few parents have direct experience with it. So instead, we’ve involved a group of public contributors with an interest in maternal and newborn health. They helped shape the review and will stay involved as the project continues.

This group highlighted important considerations, such as:

• Making sure families can easily access help after discharge, regardless of language, location, or other barriers.

• Ensuring parents are given a choice and that home is a safe, practical option.

• Listening to families’ preferences.

They also suggested additional outcomes to include in the review, like the long-term effects on babies’ gut health, how families feel about antibiotic use, and any extra costs or emergency visits after going home.

We’ve also funded two knowledge mobilisation fellows to help roll out the NOAH pathway across the region and support a wider evaluation of its impact.

We aim to bring together all the existing high-quality research and evaluations will ensure that future practice is based on the best available evidence.