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Effect of early antibiotic exposure on necrotizing enterocolitis and growth in extremely preterm infants

Katie M Strobel1, Thomas R Wood2, Gregory C Valentine2

  • 1Division of Neonatology, Department of Pediatrics, University of Washington, Seattle, WA, USA. kmstrob@uw.edu.

Pediatric Research
|February 15, 2025
PubMed

Insights

Early antibiotic exposure in extremely preterm infants is linked to higher risks of necrotizing enterocolitis (NEC) and growth faltering (GF). Limiting early antibiotic use may improve outcomes for these vulnerable infants.

Area of Science:

  • Neonatalogy
  • Pediatric critical care
  • Pharmacology

Background:

  • The impact of early antibiotic exposure on necrotizing enterocolitis (NEC) and growth faltering (GF) in extremely preterm infants remains unclear.
  • Understanding these relationships is crucial for optimizing care in neonatal intensive care units.

Purpose of the Study:

  • To investigate the association between early antibiotic exposure (first week of life) and the incidence of NEC and GF in extremely preterm infants.
  • To provide evidence-based recommendations for the judicious use of antibiotics in this high-risk population.

Main Methods:

  • Secondary analysis of data from the Preterm Erythropoietin Neuroprotection Trial.
  • Evaluation of peripartum and postnatal antibiotic exposure within the first week after birth.
  • NEC defined as Bell's stage ≥ IIA; GF defined as a z-score decrease < -0.8 for weight, length, or head circumference.
  • Multivariable analyses adjusted for maternal and infant factors.

Main Results:

  • Increased duration of infant antibiotic exposure in the first week was significantly associated with a higher hazard of NEC (aHR/day 1.14).
  • Antibiotic use for 3-7 days in the first week correlated with increased odds of weight, length, and head circumference growth faltering.
  • Findings were adjusted for relevant maternal and infant confounders.

Conclusions:

  • Early antibiotic exposure in the first week of life is associated with an increased risk of NEC in extremely preterm infants.
  • This exposure also correlates with a higher likelihood of weight, linear, and head circumference growth faltering.
  • Findings support the need for cautious and judicious administration of early antibiotics in extremely preterm neonates.
Abstract

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