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OASCN Resources | Stewardship in the NICU

These resources were developed by the OASCN Collaborative between 2021-2022.

Relevant Didactics:

  • Duration of Empiric Antibiotic Therapy for Neonatal Sepsis: How much is Enough? (Ken Zangwill): Slides | Video
  • Syphilis, Stewardship, and Assessing Algorithms (Ken Zangwill): Slides | Video
  • PDSA for Stewardship. A Creative Endeavor (Kurlen Payton): Slides | Video
  • You-TI and Antibiotic Stewardship: Chances, with challenge (Ken Zangwill): Slides | Video
  • Antimicrobial Stewardship in Preterm Infants (Bill Benitz): Slides | Video

Relevant Learning Points:

Learning Point #39: Antibiotics are recommended for preterm deliveries (<35 weeks) when due to cervical incompetence, preterm labor, PROM, intra-amniotic infection, or acute onset of unexplained nonreassuring fetal status; clinical judgement plays a role in this decision otherwise.

Learning Point #40: Every attempt should be made to perform an LP when clinically indicated.

Learning Point #41: Work to become comfortable using the most narrow spectrum antimicrobials on your antibiogram, if susceptible.

Learning Point #42: Immediate reporting of positive Gram stain/culture results should be done by the lab or by review of pending cultures at least once/day by unit staff if the lab cannot accommodate.

Learning Point #43: Hard antibiotic stops at 36 or 48 hours after blood culture have been shown consistently to safely lower antibiotic use.

Learning Point #44: Vignette research methods on antibiotic decisions and rationale guiding these decisions can help inform ideal stewardship strategies, process changes, and guideline development.

Relevant References: 

Rajar P et al. Antibiotic stewardship in premature infants: A systematic review. Neonatology 2020;117(6):673-686.

Nash C et al. Antimicrobial stewardship in the NICU: Lessons we’ve learned. NeoReviews 2014;15:e116.

McPherson C et al. Antibiotic stewardship in neonates: challenges and opportunities. Neonatal Network 2018;37:1.

Mukhopadhy S et al. Challenges and opportunities for antibiotic stewardship among preterm infants. Arch Dis Child Fetal Neonatal Ed. 2019;104(3):F327.

Johnson SJ et al. Is double coverage of gram-negative organisms necessary? Am J Health Syst Pharmacy 2011;68:119-24.