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Aberrant Growth in 5-Year-Old Children After Antibiotics in the First Week of Life
Lisanne M van Leeuwen1, Gina J van Beveren1,2, Marieke A G Peeters1
1Department of Paediatrics, Spaarne Hospital, Haarlem, the Netherlands.
Insights
Early-life antibiotic exposure, particularly certain regimens, is linked to reduced weight-for-height z-scores in children up to age five. Further research into microbiome effects is recommended.
Area of Science:
- Pediatric Growth and Development
- Microbiome Research
- Antibiotic Stewardship
Background:
- Neonatal sepsis often requires antibiotic treatment.
- Early-life antibiotic exposure can impact child development.
- Understanding long-term growth effects is crucial.
Purpose of the Study:
- To investigate the relationship between early-life antibiotics and growth up to age five.
- To compare the effects of different antibiotic regimens on child growth.
- To identify factors influencing growth in early childhood.
Main Methods:
- Analysis of two birth cohorts including healthy and sepsis-treated infants.
- Randomization of sepsis-treated infants across three antibiotic regimens.
- Longitudinal data collection on growth, diet, and environmental exposures until age five.
Main Results:
- Children exposed to early antibiotics showed lower weight-for-height z-scores (-0.26, p=0.014).
- The Augmentin+Gentamicin regimen was associated with significantly lower weight-for-height z-scores (-0.36, p=0.013).
- Higher birth weight and weekly lemonade consumption correlated with better weight-for-age and height-for-age z-scores.
Conclusions:
- First-week antibiotic use is associated with reduced weight-for-height up to age five.
- The impact on growth varies depending on the specific antibiotic regimen used.
- Further research is needed to explore microbiome alterations and their role in growth outcomes.
Aim:
We examined the relationship between early-life antibiotics, different regimens, and growth until age five years.
Methods:
Data from two parallel birth cohorts were analysed: 128 healthy term-born children and 147 term-born children who received antibiotics for suspected neonatal sepsis, randomised across three regimens: Amoxicillin+Cefotaxime, Augmentin+Gentamicin, Penicillin+Gentamicin. Until age five years, growth, environmental exposures, diet, and physical activity data were collected. Primary outcomes were weight-for-age, height-for-age, and weight-for-height z-scores with early-life antibiotic exposure and the regimen as determinants of interest.
Results:
The median antibiotic exposure duration was 3 days (interquartile range 2.4-5.5 days). Children exposed to early-life antibiotics had on average 0.26 lower weight-for-height z-scores over the first five years compared to unexposed controls (p = 0.014). Especially children treated with Augmentin+Gentamicin showed lower weight-for-height z-scores, compared to unexposed controls (coefficient = 0.36; p = 0.013). Additionally, at age five years, higher birth weight percentiles were associated with higher weight-for-age, height-for-age and weight-for-height and weekly lemonade consumption was associated with higher weight-for-age z-scores.
Conclusion:
Antibiotics in the first week of life are associated with lower weight-for-height up to age five years, with effects varying by treatment type. To explain these effects, further examination of antimicrobial-induced early-life microbiome perturbations and subsequent growth is needed.
Trial Registration:
International Clinical Trial Registry Platform (https://trialsearch.who.int/): NL4882 and NL3821.
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