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Prolonged duration of early antibiotic therapy in extremely premature infants

Rachel G Greenberg1, Dhuly Chowdhury2, Nellie I Hansen2

  • 1Department of Pediatrics, Duke University School of Medicine, Durham, NC, USA. rachel.greenberg@duke.edu.

Pediatric Research
|February 10, 2019
PubMed

Insights

Prolonged early antibiotic use in extremely premature infants decreased but varied by center. This treatment was not linked to higher death or necrotizing enterocolitis (NEC) rates.

Area of Science:

  • Neonatal research
  • Pediatric pharmacology
  • Infectious disease epidemiology

Background:

  • Early antibiotic administration in extremely premature infants is common but may have adverse effects.
  • The necessity of prolonged antibiotic use without confirmed infection or necrotizing enterocolitis (NEC) is debated.
  • Understanding the prevalence and outcomes of this practice is crucial for optimizing neonatal care.

Purpose of the Study:

  • To assess the prevalence of prolonged early antibiotic use in extremely premature infants.
  • To evaluate the association between prolonged early antibiotics and adverse outcomes, including death and NEC.
  • To examine variations in this practice across different clinical centers and over time.

Main Methods:

  • A cohort study included 5730 infants born between 2008-2014 at 13 centers.
  • Infants were born between 22-28 weeks gestation and weighed 401-1000 grams.
  • Prolonged early antibiotics were defined as ≥5 days of therapy initiated within 72 hours of age; outcomes were assessed using multivariable logistic regression.

Main Results:

  • The proportion of infants receiving prolonged early antibiotics ranged from 30-69% across centers and decreased from 49% in 2008 to 35% in 2014.
  • Prolonged early antibiotics were not significantly associated with an increased risk of death (aOR 1.17; 95% CI: 0.99-1.40).
  • No significant association was found between prolonged early antibiotics and necrotizing enterocolitis (NEC).

Conclusions:

  • The use of prolonged early antibiotics in extremely premature infants has declined but shows persistent variation among centers.
  • This practice was not significantly associated with increased mortality or NEC in the studied cohort.
  • Further research may be needed to establish optimal antibiotic stewardship in neonatal intensive care.
Abstract

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