Safe Reduction of Antibiotic Use in Inborn Term Neonates with Mild Fever After Improvements in Antibiotic Use Strategies

Background: Fever is a common reason for admission to neonatal intensive care units (NICUs). Studies have shown that 5–15% of infants presenting with fever ≥ 38 °C develop serious bacterial infections. However, research on infectious outcomes among infants with mild fever (37.6 °C to <38 °C) remains scarce. Current guidelines suggest preventive use of antibiotics in these patients. Based on the comparatively low incidence of sepsis in this group and the adverse effects of antibiotic overuse, it may be feasible to avoid empiric antibiotic use through close monitoring and laboratory testing in low-risk term infants with mild fever. Methods: This prospective pre–post quasi-interventional quality improvement study was conducted in a level IV NICU. The departmental consensus since 2021 has been that inborn term infants with mild fever (37.6 °C to <38 °C) and without risk factors should be monitored for vital signs and infection-related manifestations and should not receive antibiotics until persistent fever, abnormal symptoms, or abnormal test results occur. However, low adherence and high antibiotic exposure were observed. Therefore, the Plan–Do–Study–Act cycles were launched in February 2022 and included adherence barrier analysis, monthly standardized staff training, and daily real-time prescription audits to improve medical staff adherence to the consensus. The primary process measure was the adherence rate to the consensus. The primary outcome measure was antibiotic exposure rate before discharge. The main safety outcome was blood-culture-positive cases. Results: Adherence to the consensus improved from 41.7% to 81.9%. During this period, among low-risk term infants with mild fever, the antibiotic exposure rate before discharge decreased from 94.4% to 60.8%, representing a 33.6% reduction from baseline. Higher adherence was associated with reduced odds of antibiotic exposure during hospitalization. The microbiologically documented infection rates (all cases were culture-proven early-onset sepsis) were similar between the baseline and intervention periods (0.9% vs. 0.6%). Conclusions: Implementing interventions to increase adherence to mild fever management guidelines for low-risk term infants was associated with decreased antibiotic exposure.