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Published on: February 17, 2023
Perinatal antibiotic exposure and risk of childhood infections: a retrospective cohort study
Sarah A Coggins1,2,3, William Quarshie3, Robert W Grundmeier2,3,4
1Division of Neonatology, Children's Hospital of Philadelphia, Philadelphia, PA, USA.
Insights
Perinatal antibiotic exposure, including during childbirth and infancy, was not linked to an increased risk of childhood infections requiring hospitalization in a study of nearly 14,000 infants. This research clarifies the impact of early antibiotic use on infection risk.
Area of Science:
- Pediatric infectious diseases
- Neonatal and perinatal medicine
- Pharmacoepidemiology
Background:
- Epidemiological studies suggest a link between antibiotic exposure in early life and increased childhood infection risk.
- The specific impact of intrapartum (during childbirth) and neonatal (newborn) antibiotic exposure on infection risk remains unclear.
Purpose of the Study:
- To investigate the association between perinatal antibiotic exposure and infection-related inpatient encounters in early childhood.
- To examine the role of early infant antibiotic exposure (first three months) on subsequent infection risk.
Main Methods:
- Retrospective cohort study of 13,919 healthy term infants followed up to age 6.
- Primary exposure: perinatal antibiotics (intrapartum or neonatal within 3 days of birth).
- Primary outcome: infection-related inpatient encounters; analyzed using Cox proportional hazards and marginal models.
Main Results:
- Perinatal antibiotic exposure occurred in 28% of infants.
- No significant association was found between perinatal antibiotic exposure and infection-related hospitalizations (aHR 1.16, p=0.15).
- Early infant antibiotic use also showed no association with infection-related hospitalizations.
Conclusions:
- Perinatal and early infant antibiotic exposure does not appear to increase the risk of hospitalization for infections in early childhood.
- Findings suggest that antibiotic use around the time of birth may not significantly impact the risk of subsequent infectious disease hospitalizations.
Background:
Epidemiological studies report associations between antibiotics given during pregnancy, childbirth, and infancy and subsequent risk for childhood infections. The specific role of intrapartum and neonatal antibiotic exposures is not well-described.
Methods:
Retrospective cohort study of healthy term infants through 6 years of age. The primary exposure was perinatal antibiotics, defined as intravenous intrapartum antibiotic administration during the admission for childbirth or administered to the infant ≤3 days after birth. The primary outcome was infection-related inpatient encounters. Adjusted multivariable-adjusted Cox proportional hazards and marginal means/rates models were used to investigate the association between exposure and outcome. A secondary analysis examined the association between early infant antibiotics administered during the first three months after birth, including perinatal antibiotics, and the outcome.
Findings:
Of 13,919 infants, 3936 (28%) had perinatal antibiotic exposure. 1294 (9.3%) children had 1619 inpatient encounters, of which 988 (61%) were infection-related. Infection-related inpatient encounters occurred in 265 (6.7%) children exposed to perinatal antibiotics, compared to 584 (5.8%) unexposed children (risk difference 1.2%, 95% CI 0.3-2.1%, p = 0.005). In multivariable-adjusted models, perinatal antibiotic exposure was not associated with infection-related inpatient encounters [Cox model: aHR 1.16, 95% CI 0.95, 1.51, p = 0.15; marginal rates/means model: aHR 1.22, 95% CI 0.98, 1.51, p = 0.08]. Early infant antibiotics were also not associated with the outcome.
Interpretation:
In this study of 13,919 newborns across 24 primary pediatric practices, perinatal or early infant antibiotic exposure was not associated with subsequent early childhood hospitalization for infectious diseases.
Funding:
Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, funding (K23 HD088753) supported this study.
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