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Published on: October 31, 2025

Association between early postnatal antibiotic exposure and bronchopulmonary dysplasia in very preterm infants: a

Cheng Min1, Ying Sui1, Qu Chen1

  • 1Neonatal Intensive Care Unit, Huzhou Maternity & Child Healthcare Hospital, Huzhou, Zhejiang, China.

Frontiers in Pediatrics
|July 31, 2026
PubMed

Insights

Early antibiotic exposure in very preterm infants increases risks for bronchopulmonary dysplasia (BPD) and mortality. Optimizing antibiotic use is crucial for improving long-term outcomes in these vulnerable infants.

Area of Science:

  • Neonatal Medicine
  • Pediatric Pharmacology
  • Infectious Diseases

Background:

  • Very preterm infants have immature immune systems, increasing infection risk.
  • Empirical antibiotic therapy is common but may have adverse effects.
  • Understanding antibiotic impact on infant outcomes is vital for neonatal care.

Purpose of the Study:

  • To systematically evaluate the association between early postnatal antibiotic exposure and bronchopulmonary dysplasia (BPD) in very preterm infants.
  • To assess the link between early antibiotic use and other adverse outcomes like necrotizing enterocolitis (NEC), mortality, and late-onset sepsis (LOS).
  • To provide evidence for optimizing antibiotic stewardship in neonatal intensive care units.

Main Methods:

  • Systematic literature search of PubMed, Embase, Wiley, and Cochrane Library databases up to March 2026.
  • Inclusion of observational cohort studies comparing early vs. no/short-term antibiotic exposure.
  • Meta-analysis of primary outcome (BPD) and secondary outcomes (NEC, mortality, LOS) using fixed/random-effects models; sensitivity and bias analyses performed.

Main Results:

  • Eleven studies included; early antibiotic exposure significantly increased BPD risk (OR 1.44, 95% CI: 1.12-1.85).
  • Increased risks observed for NEC (OR 1.18, 95% CI: 1.09-1.28) and mortality (OR 1.19, 95% CI: 1.05-1.35).
  • No significant association found for late-onset sepsis; results remained stable after sensitivity analysis, though mortality interpretation requires caution due to publication bias.

Conclusions:

  • Early postnatal antibiotic exposure is linked to higher risks of BPD and mortality in very preterm infants.
  • Careful assessment of infection risk and optimized antibiotic strategies are essential.
  • Improving antibiotic stewardship can enhance long-term outcomes for vulnerable preterm neonates.
Abstract

Keywords:
antibioticsbronchopulmonary dysplasiameta-analysismortalitynecrotizing enterocolitissepsisvery preterm infants

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