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Early initiation of broad-spectrum antibiotics in premature infants

Suzan Asfour1, Mountasser Al-Mouqdad2

  • 1NICU Department, King Saud Medical City - Pediatric Hospital, Riyadh, Saudi Arabia.

Minerva Pediatrics
|November 16, 2019
PubMed

Insights

Early broad-spectrum antibiotics in premature infants increase risks of serious complications like late-onset sepsis and death. Restricting their use in the first week of life is recommended to improve infant outcomes.

Area of Science:

  • Neonatal Medicine
  • Pediatric Infectious Diseases
  • Pharmacology

Background:

  • Neonatal sepsis is a major cause of mortality in premature infants.
  • Early empirical broad-spectrum antibiotics may elevate risks of complications, including late-onset sepsis.
  • This study investigates complications linked to early broad-spectrum antibiotic use in neonates.

Purpose of the Study:

  • To examine complications associated with empirical broad-spectrum antibiotic administration in the first week of life for premature infants.
  • To identify risks such as late-onset sepsis, necrotizing enterocolitis, and mortality.

Main Methods:

  • Retrospective study of 365 neonates (gestational age ≤32 weeks, birth weight <1500 g) who survived the first week without confirmed sepsis.
  • Data collected from July 2015 to June 2018 in a tertiary Neonatal Intensive Care Unit.
  • Primary outcome: composite of late-onset sepsis, necrotizing enterocolitis, and mortality. Secondary outcomes included individual components and bronchopulmonary dysplasia.

Main Results:

  • Broad-spectrum antibiotics were administered to 75 (20.5%) of the infants.
  • Multivariate regression showed a significant independent association between broad-spectrum antibiotic use and adverse outcomes.
  • The composite outcome (late-onset sepsis, necrotizing enterocolitis, death) occurred with an odds ratio of 3.03 (95% CI: 1.41-6.49).

Conclusions:

  • Empirical broad-spectrum antibiotic use in the first week of life is linked to severe adverse outcomes in premature infants.
  • Restricting the use of these antibiotics during the initial week of life is advisable.
  • This approach may help mitigate risks and improve survival and health outcomes for vulnerable neonates.
Abstract

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