PenARC is pleased to highlight the successful implementation of a pioneering care pathway that is transforming the management of suspected early-onset infections (EOI) in newborns.
Developed and piloted for 6 months at the Royal Devon University Healthcare NHS Foundation Trust (RDUH), the Neonatal Oral Antibiotics at Home (NOAH) pathway enables eligible newborns to complete their antibiotic treatment at home after 36 hours of hospital care. This approach involves transitioning from intravenous (IV) to oral antibiotics, supporting earlier discharge while maintaining patient quality of care.
Significant Benefits for Families and the Health System
Following on from the pilot at the Royal Devon and Exeter Hospital site, the NOAH pathway is now embedded in routine clinical practice, delivering measurable benefits across several key areas:
- An average reduction of 2.7 hospital bed days per baby
- Estimated annual cost savings of £66,500 for the Trust
- Reduced antibiotic exposure, with gentamicin doses decreasing from an average of 3 to 1.7 per baby
- 97% of staff reported positive impacts for babies, families, and the wider hospital environment
- An estimated 8,230kg of CO₂ emissions avoided annually, contributing to NHS Net Zero targets
One parent who participated in the pilot commented:
“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.”
Addressing Challenges in Rural Healthcare Delivery
In the UK, standard management of suspected EOI involves a minimum of 36 hours of IV antibiotics. If concerns persist, treatment may extend to seven days. This can place a considerable burden on families in rural regions such as Devon, where access to neonatal units is limited and travel distances are often long.
The NOAH pathway provides a safe, effective solution to these challenges, reducing the need for extended hospital stays and alleviating pressure on neonatal bed capacity. In areas with limited neonatal intensive care provision, such as the South West, this approach supports more efficient use of available resources and helps prevent families from needing to travel considerable distances for care.
Evaluation and Future Rollout
An independent evaluation by Health Innovation South West confirmed the effectiveness, and acceptability of the NOAH pathway. Implementation resources have since been developed to support the adoption of this model by other neonatal teams regionally and nationally.
Professor Stuart Logan, PenARC Director, 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.