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Antibiotics Use and Its Effects on the Establishment of Feeding Tolerance in Preterm Neonates

Neel K Singh1, Lester Will1, Sharef Al-Mulaabed2

  • 1Department of Pediatrics, Division of Neonatology, Shands Children's Hospital, University of Florida, Gainesville, Florida.

American Journal of Perinatology
|June 12, 2023
PubMed

Insights

Early antibiotic use in preterm infants did not affect feeding tolerance. Further research is needed to confirm these findings in neonates receiving antibiotics.

Area of Science:

  • Neonatal Intensive Care Unit (NICU) practices
  • Pediatric gastroenterology
  • Antibiotic stewardship

Background:

  • Antibiotics are extensively used in NICUs, often for symptomatic preterm infants without confirmed sepsis.
  • Concerns exist regarding antibiotic impact on intestinal function and microbiome in neonates.
  • Previous studies in older infants suggest potential for dysmotility and dysbiosis following antibiotic exposure.

Purpose of the Study:

  • To investigate the hypothesis that early antibiotic administration affects enteral feeding tolerance in high-risk preterm infants.
  • To evaluate the impact of antibiotics on feeding advancement in neonates.

Main Methods:

  • A randomized controlled trial (Routine Early Antibiotic Use in SymptOmatic Preterm Neonates - REASON study) was conducted.
  • Symptomatic preterm newborns without maternal infection risk factors were randomized to receive or not receive antibiotics.
  • Feeding tolerance was assessed in both groups.

Main Results:

  • No significant differences in sustained feeding tolerance were observed between preterm neonates who received antibiotics and those who did not.
  • The study found no difference in feeding issues based on early antibiotic exposure when analyzing the randomized controlled trial data alone.

Conclusions:

  • Early antibiotic administration in preterm infants, as per this study, did not demonstrate an impact on feeding tolerance.
  • The study highlights limitations due to sample size and clinical crossovers, underscoring the need for a robust prospective randomized study.
  • Further investigation is required to definitively ascertain the relationship between early antibiotic use and feeding outcomes in neonates.
Abstract

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