Optimising Antibiotic use in the Neonatal Intensive Care Unit through Implementation of Antimicrobial Stewardship Program: A Double Cohort Study

Introduction: Inappropriate use of antimicrobials in newborns can lead to serious consequences, including the emergence of multidrug-resistant organisms. Implementing antimicrobial stewardship strategies in neonatal units can reduce indiscriminate antibiotic use and its harmful effects. Aim: To study the effect of reducing antibiotic usage in newborns admitted to the Neonatal Intensive Care Unit (NICU) by creating a “No Antibiotic Zone” and implementing an Antimicrobial Stewardship Program (ASP). Materials and Methods: This double-cohort observational study was conducted in a Level III NICU at the Children’s Hospital, GSVM Medical College, Kanpur, Uttar Pradesh, India, from April 2021 to March 2023. During the preintervention period, most neonates were administered antibiotics irrespective of risk factors. During the stewardship period, neonates were assessed for red flags, risk factors and clinical indicators of sepsis. Neonates with minimal or no risk factors or clinical signs of sepsis (n=480) were placed in an aseptic “No Antibiotic Zone” within the NICU under close monitoring. Those who exhibited early signs of sepsis (n=178) were started on antibiotics and managed according to standard guidelines. Demographic and clinical characteristics, length of hospital stay and outcomes were compared between the preintervention (n=464) and postintervention (n=302) cohorts. Results: The baseline characteristics of the newborns, including gender, gestational age, birth weight and incidence of various diseases, were comparable between the two cohorts. The mean gestational age and birth weight were 36±2.06 weeks and 2400±500 g, respectively. The mean length of stay before the intervention was 10.1±2.8 days, which decreased to 6.5±2.4 days after the implementation of the ASP (p-value <0.001). Antimicrobial utilisation in the NICU declined by 42% without a corresponding increase in mortality, which was statistically significant (p-value <0.001). Conclusion: Given the growing threat of antimicrobial resistance, implementation of antimicrobial stewardship strategies—though challenging—can effectively minimise unnecessary antibiotic use in newborns.