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Association of Neonatal Antibiotic Exposure with Long-Term Growth Trajectory Faltering in Preterm-Birth Children
Yung-Chieh Lin1, Chi-Hsiang Chu2,3, Yen-Kuang Lin4
1Department of Pediatrics, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan, drapple@mail.ncku.edu.tw.
Insights
Neonatal antibiotic exposure negatively impacts preterm infant growth. Longer antibiotic duration in the neonatal period is associated with reduced body weight, height, and BMI z-scores up to 5 years corrected age.
Area of Science:
- Neonatology
- Pediatric Growth and Development
- Antibiotic Stewardship
Background:
- Preterm neonates frequently receive antibiotics during their hospital stay.
- The long-term effects of neonatal antibiotic exposure on growth are not fully understood.
Purpose of the Study:
- To investigate the association between the duration of neonatal antibiotic exposure and longitudinal growth in preterm children.
Main Methods:
- Prospective study of 328 preterm infants (born <32 weeks gestation) followed from 6 to 60 months corrected age.
- Exclusion of infants with specific morbidities (e.g., bacteremia, NEC).
- Analysis of anthropometric trajectories (z-scores for weight, height, BMI) in relation to antibiotic exposure duration.
Main Results:
- Antibiotic exposure duration was negatively associated with body weight (zBW), body height (zBH), and body mass index (zBMI) z-scores.
- Children with >15 days of neonatal antibiotics showed significantly lower zBW, zBH, and zBMI at multiple time points up to 60 months corrected age.
- Multivariate analyses confirmed faltering z-score increments in zBW and zBH with increased antibiotic exposure duration.
Conclusions:
- Antibiotic exposure duration in preterm neonates is linked to impaired longitudinal growth.
- Antibiotic stewardship and vigilant growth monitoring are crucial for preterm infants receiving antibiotics.
Introduction:
Preterm neonates often receive a variety of duration of antibiotic exposure during admission. The aim of the study was to evaluate whether neonatal antibiotic exposure is relevant with longitudinal growth problems in preterm-birth children.
Methods:
This prospective study enrolled 481 infants who were born <32 weeks of gestation, discharged, and longitudinally followed from corrected age (CA) 6-60 months. After excluding 153 infants with blood culture-confirmed bacteremia, necrotizing enterocolitis, severe cerebral palsy, intestinal ostomy, and congenital anomaly, 328 infants were included for analysis. Covariates included perinatal demographics, neonatal morbidities, extrauterine growth restriction, and antibiotic exposure accumulated by term equivalent age. The primary outcome was the anthropometric trajectories in z-score of bodyweight (zBW), body height (zBH), and body mass index (zBMI) from CA 6-60 months.
Results:
Antibiotic exposure duration was significantly negatively associated with zBW and zBH at CA 6, 12, and 60 months, and zBMI at CA 60 months. Multivariate generalized estimating equation analyses showed antibiotic exposure duration had significantly faltering z-score increment from CA 6 to 60 months in zBW and zBH (adjusted mean [95% CI]; ΔzBW: -0.021 [-0.041 to -0.001], p = 0.042; ΔzBH: -0.019 [-0.035 to -0.002], p = 0.027) after adjustment. Children with neonatal antibiotic exposure duration >15 days were significantly lower in the mean anthropometric zBW, zBH, and zBMI at CA 6, 12, 24, and 60 months compared with children with neonatal antibiotic exposure ≤15 days (all p < 0.01).
Conclusions:
Growth increments were negatively associated with antibiotic exposure duration in preterm neonates implicating that antibiotic stewardship and growth follow-up for preterm neonates are thus warranted.
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