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Prolonged use of antibiotics after birth is associated with increased morbidity in preterm infants with negative

Carlos Fajardo1, Belal Alshaikh2, Andrei Harabor3

  • 1Department of Pediatrics, University of Calgary, Peter Lougheed Centre, Calgary, AB, Canada.

The Journal of Maternal-Fetal & Neonatal Medicine : the Official Journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians
|May 25, 2018
PubMed

Insights

Prolonged antibiotic use in preterm infants with negative cultures increases risks for neonatal morbidities like late-onset sepsis and bronchopulmonary dysplasia. Limiting antibiotic courses to 5 days or less may improve outcomes for these vulnerable infants.

Area of Science:

  • Neonatal Medicine
  • Pediatric Pharmacology
  • Infectious Diseases

Background:

  • Most preterm infants receive antibiotics post-birth, even with negative cultures.
  • Emerging data highlight risks associated with prolonged antibiotic exposure.
  • This study investigates the link between initial antibiotic duration and neonatal outcomes.

Purpose of the Study:

  • To assess the association between the length of initial antibiotic therapy and neonatal outcomes.
  • To evaluate risks of prolonged antibiotic use in very preterm infants with negative cultures.
  • To inform clinical guidelines on antibiotic stewardship in neonatal intensive care.

Main Methods:

  • Retrospective cohort study of infants <1250g with negative blood/CSF cultures in the first 2 days.
  • Data collected over a 4-year period at a single large perinatal center.
  • Multivariable regression analysis used to evaluate composite outcomes (NEC, LOS, death).

Main Results:

  • Infants receiving >5 days of antibiotics were smaller, younger, and had more maternal chorioamnionitis.
  • Longer antibiotic courses (>5 days) were associated with increased rates of composite outcomes (OR 1.83), late-onset sepsis (OR 2.02), and bronchopulmonary dysplasia (OR 1.58).
  • No significant differences in mortality or necrotizing enterocolitis were observed.

Conclusions:

  • Extended antibiotic treatment (>5 days) in very preterm infants with negative cultures correlates with higher morbidity, including bronchopulmonary dysplasia.
  • Findings suggest a need for prospective trials to establish optimal antibiotic protocols.
  • Antibiotic stewardship is crucial for managing very preterm infants.

Keywords:
Pretermantibioticsbronchopulmonary dysplasiamicrobiomemorbidity

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