Abstract 1617 Poster Session II, Sunday, 5/2 (poster 111)

Objective: To determine the feasibility and cost-effectiveness of home antibiotic therapy for a select group of neonates compared with continued in-hospital treatment.

Methods: Neonates at a university hospital who met criteria for home antibiotic therapy at discharge were prospectively followed during the period from November 1995 through October 1997. Exclusion criteria included those neonates with culture-proven gram-negative infection.

Results: During the study period, 98 infants diagnosed with sepsis, presumed sepsis, pneumonia, or uncomplicated meningitis (having received >10 days of in-hospital therapy) met criteria for home antibiotic therapy. The mean S.D. birth weight of the cohort was 3160±526 grams with a mean gestational age of 38.4±2.1 weeks. The average age at discharge was 5 days. The average number of days the infants received home therapy was 4.7±3.9 days (median # 4 days). Thirty-one infants (32.6%) of the cohort received antimicrobial therapy for a clinical presentation consistent with sepsis or presumed sepsis with abnormal white blood cell indices; 24 (24.5%) infants were diagnosed with pneumonia. A maternal risk factor consistent with an infectious process was the next most common reason for home antibiotic therapy (11.2%). Ampicillin and gentamicin therapy formed the mainstay of home antibiotic therapy (n=53; 54.1%) with ceftriaxone the next most frequently prescribed therapy at the time of discharge (n=20; 20.4%). Seventy patients in the cohort had bilirubin levels drawn prior to discharge. The highest bilirubin mean for the group was 10.4±0.5 mg/dL (range 1-18.6). Prior to discharge, the mean bilirubin level had decreased to 8.1±0.4 mg/dL (0.8-14.9). Of the infants to be discharged to home of ceftriaxone, the range of bilirubin levels was 0.8 to 10.7. Four infants of those infants whose bilirubin was ≥28 were switched to ampicillin and gentamicin therapy. No infants were rehospitalized for hyperbilirubinemia. An additional 4 infants were switched from i.v. ampicillin/gentamicin therapy to i.m. ceftriaxone after discharge due to loss of i.v. access. There were no rehospitalizations secondary to a worsening clinical course. As compared with a 10-day inpatient stay, 5 days of in-hospital care and 5 days of outpatient therapy provided averaged savings of $1200 (for every 8-hour drug administration) or $2250 (with once daily antibiotic dosing).

Conclusions: In this cohort, neonates who met home antibiotic therapy criteria were discharged to home earlier, without serious complications or treatment failures, and with fewer medical costs than if they had continued to receive treatment in the inpatient setting. In addition, parental bonding was facilitated while decreasing the further risk of nosocomial infection.