Discharging Low-risk Neonates With Suspected Sepsis on Oral Antibiotics: An 18-Month Experience

To the Editors: Kumar et al and Keij et al1,2 reported the safety of oral antibiotics for the treatment of neonatal early-onset sepsis presenting with clinical signs in babies in India and the Netherlands. On the basis of the likely safety of such practice, we introduced a new policy (Oxford University Hospitals NHS FT) in January 2023, which permits a low-risk subset of babies with suspected early-onset neonatal sepsis to be discharged home on oral antibiotics. Previously, all babies in which a sepsis screen was performed for risk factors rather than clinical signs and where there was a C-reactive protein (CRP) >10 mg/dL received a 5-day course of intravenous antibiotics. Following the introduction of the new guidance, babies with no clinical signs and maximal CRP <25 mg/dL received 36 hours intravenous antibiotics and were then discharged on oral Augmentin, to complete 5-days total antibiotics. We performed a retrospective audit (OUH NHS FT audit submission: audit number 9943) over 18 months, January 2023–July 2024, to assess the safety of this practice. In total 1604 babies had a CRP measured as part of a sepsis screen in the first week of life. Of these, 476 babies had at least one CRP >10 mg/dL; and of these,127 (27%) were discharged on oral Augmentin (349 babies, 73%, continued a full course of intravenous antibiotics). We retrospectively reviewed the clinical records of all babies discharged on oral antibiotics to assess the readmission rate. Of the 127 babies, 5 babies were readmitted through the emergency department. Two babies had feeding difficulties and no infection. Two babies had viral infections (1 confirmed as bronchiolitis), and one had balanitis. No babies were admitted with symptoms consistent with a recurrence of bacterial early-onset sepsis. Our results show that this change in policy allows a significant number of newborns to be discharged early. This practice appears to be safe and does not lead to any readmissions from undertreated infections.