OSCE stationSP stationEarly-onset sepsis
A communication station: explaining the NICE oral-switch pathway to a parent whose baby can finish antibiotics at home.
You are the neonatal registrar. Baby Sami, born at 37+4 weeks, started intravenous antibiotics soon after birth because the initial clinical suspicion of infection was strong. He is now 40 hours old.
His blood culture is negative, he is clinically well with no signs of infection, his CRP levels and trend are reassuring, and he is feeding well. Your consultant has agreed that he can switch to oral amoxicillin under NICE NG195 and go home if his parents agree. Discuss the plan with his mother.
Suggested time: 9 minutes
You are Grace, Sami's mother. You are pleased but anxious about giving medicine at home.
Opening line: “They said he might come home on medicine. Is it safe to stop the drip?”
Questions to raise if the candidate doesn’t cover them:
- Why does he need more antibiotics if the blood test was clear?
- How long will he be on it?
- What if I get the medicine wrong?
- What if he gets sick at home — who do I call?
- Will anyone check on him?
Questions
Why does he need more antibiotics if the blood test was clear?
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- The initial concern about infection was strong, so treatment continues beyond 36 hours even though the blood culture is negative.
Why is it safe to switch to medicine by mouth?
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- He meets the NICE criteria: born from 35+0 weeks, negative blood culture, clinically reassuring with no current signs of ongoing infection, reassuring CRP levels and trend, and tolerating oral feeds.
- A senior doctor (consultant level) has agreed the switch.
How long will he be on it?
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- Oral amoxicillin completes the course, up to 7 days of antibiotics in total.
What if I get the medicine wrong?
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- She will be trained to give it and will give the first dose under supervision before leaving hospital.
What if he gets sick at home, and will anyone check on him?
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- Before going home she will know when and how to get help from the neonatal team, and any concerns will be addressed.
- Sami stays under the neonatal team, with at least 2 follow-up consultations, including 1 at the end of treatment.
- Home treatment is her choice; he can stay in hospital if she prefers.
Based on: NICE guideline NG195, Neonatal infection: antibiotics for prevention and treatment (2021, last updated May 2026).
Tiny Taught · Neonatal & Paediatric Education
Teaching material for exam preparation. Doses and thresholds are for orientation only; follow your local guidelines.