Early antibiotics and risk for necrotizing enterocolitis in premature infants: A narrative review

Area of Science:

• Neonatal Medicine
• Microbiome Research
• Pediatric Gastroenterology

Background:

• Prompt antibiotic initiation at birth for suspected early-onset sepsis is common in preterm infants.
• This practice can lead to unnecessary antibiotic exposure, particularly in infants with negative blood cultures.
• Early antibiotic exposure is linked to alterations in the developing gut microbiome, potentially increasing disease risk.

Purpose of the Study:

• To review and clarify the complex relationship between early antibiotic exposure and necrotizing enterocolitis (NEC) risk in preterm infants.
• To summarize findings from human and animal studies on early antibiotics and NEC.
• To explore potential mechanisms and identify future research directions.

Main Methods:

• Narrative review of existing human and animal studies.
• Analysis of findings regarding the association between early antibiotic exposure and NEC.
• Exploration of study limitations and potential biological mechanisms.

Main Results:

• Conflicting evidence exists regarding the impact of early antibiotics on NEC risk, with some studies showing increased risk and others showing decreased risk.
• Animal models also present divergent findings on the protective or detrimental effects of early antibiotics on NEC susceptibility.
• Significant limitations in current research hinder definitive conclusions.

Conclusions:

• The precise relationship between early antibiotic exposure and NEC in preterm infants remains unclear due to conflicting study results and methodological limitations.
• Further research is needed to elucidate the mechanisms by which early antibiotics may influence NEC risk.
• Understanding these mechanisms is crucial for optimizing antibiotic stewardship in neonatal care.