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Remote Stewardship for Medically Underserved Nurseries: A Stepped-Wedge, Cluster Randomized Study.

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This summary is machine-generated.

A remote antibiotic stewardship program (ASP) significantly reduced antibiotic exposure in underserved newborn nurseries. This telestewardship approach proved safe and effective, with manageable time demands for providers.

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Area of Science:

  • Neonatal care
  • Infectious disease management
  • Public health

Background:

  • Antibiotic overuse in newborns is linked to adverse outcomes.
  • Medically underserved centers often lack dedicated pediatric antibiotic stewardship programs (ASPs).
  • Telestewardship offers a potential solution to bridge this disparity in care.

Purpose of the Study:

  • To evaluate the effectiveness and safety of a nursery-specific ASP delivered remotely.
  • To assess the impact of telestewardship on antibiotic use in underserved newborn nurseries.

Main Methods:

  • A 3-year stepped-wedge, cluster-randomized trial in 8 underserved newborn nurseries.
  • Implementation of a remote ASP including education, audit, feedback, and 24/7 expert consultation.
  • Outcomes measured included antibiotic exposure, total antibiotic use, length of stay, transfer rates, sepsis, and mortality.

Main Results:

  • Infant antibiotic exposure decreased from 6.2% to 4.2% post-intervention (RR 0.68).
  • Total antibiotic use declined by 28% (84.1 days of therapy per 1000 patient-days).
  • No significant safety concerns or adverse events were observed.

Conclusions:

  • Remote ASP implementation successfully reduced antibiotic exposure and overall use in underserved newborn nurseries.
  • The telestewardship model was safe, effective, and time-efficient.
  • Remote stewardship is a viable strategy for optimizing antibiotic use in vulnerable neonatal populations.