When newborn babies are suspected of having an infection, they are routinely given intravenous (IV) antibiotics as a precaution. Around 10% of babies receive IV antibiotics after birth, but most will not have a confirmed infection.
For some babies, particularly where symptoms are unclear, antibiotics need to continue for 5–7 days. This can result in avoidable hospital stays, repeated painful procedures, increased costs and separation from parents during an important period for bonding. It also places additional pressure on neonatal units and their capacity.
The team behind the Neonatal Oral Antibiotics at Home (NOAH) project asked whether there was a safer way for some babies to complete their treatment without remaining in hospital.
Led by clinicians at Royal Devon University Healthcare NHS Foundation Trust, in partnership with Health Innovation South West and PenARC, the team developed a new pathway enabling eligible babies to switch from IV to oral antibiotics and complete their treatment at home. The pathway was co-designed with parents and included clear clinical criteria, antimicrobial stewardship principles, parent education, safety-netting and follow-up support.
The evaluation showed that the pathway was safe, effective and acceptable to families and staff. Babies could leave hospital an average of 2.7 days earlier, with no increase in late infections, mortality or readmissions. Parents reported improved bonding, breastfeeding, confidence and mental wellbeing, while staff feedback was overwhelmingly positive.
The impact has now extended well beyond the original pilot. Neonatal oral antibiotic pathways have been implemented across nine NHS trusts and three neonatal networks, with additional trusts working towards adoption. The implementation resources have also been downloaded more than 100 times.
Most significantly, the research and learning from NOAH has contributed to a change in national guidance. In May 2026, NICE updated its guidance on neonatal infection, recommending that clinicians consider switching eligible babies from IV to oral antibiotics after 36 hours, and consider enabling parents or carers to complete their baby’s treatment at home with support from the neonatal team.
For babies and their families, this can mean getting home sooner, spending more time together and avoiding unnecessary hospital procedures. For neonatal services, shorter hospital stays release valuable cot capacity and improve patient flow. The pathway is estimated to avoid £1,900–£2,500 per baby, with the original pilot site saving around £66,000 each year.
If adopted nationally, an estimated 9,000–12,000 babies could benefit each year, with potential cost avoidance of up to £30 million annually, alongside improved family experience and increased neonatal capacity.
From identifying a problem, to generating evidence, supporting implementation and influencing national guidance, NOAH demonstrates how NIHR-supported research can make a tangible difference to babies, families and the NHS.