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Balancing Overtreatment and Safety: Impact of 2023 Guideline Change on Antibiotic Use in Late Preterm Infants

Dogan Kaymaz1, Deniz Uzun2, Ferhan Demirtas1

  • 1Department of Neonatology, Ankara University Faculty of Medicine, Ankara, Türkiye.

Turkish Archives of Pediatrics
|August 1, 2026
PubMed

Insights

The 2023 guideline revision increased the gestational age threshold for empirical antibiotics to <35 weeks, leading to more neonatal intensive care unit (NICU) admissions and antibiotic exposure in preterm infants without improving early-onset neonatal sepsis (EONS) detection.

Area of Science:

  • Neonatal Medicine
  • Pediatric Infectious Diseases
  • Clinical Guidelines

Background:

  • National guidelines for neonatal infections recommend empirical antibiotic initiation based on gestational age.
  • A recent revision raised the threshold from <34 to <35 weeks for infants born at 34 0/7-34 6/7 weeks.

Purpose of the Study:

  • To assess the impact of the 2023 guideline revision on hospitalization and antibiotic exposure in infants born at 34 0/7-34 6/7 weeks.
  • To evaluate the change in neonatal intensive care unit (NICU) admissions and empirical antibiotic use.

Main Methods:

  • Retrospective cohort study of 272 infants born between April 2018 and September 2023.
  • Infants were evaluated under both 2018 and 2023 Turkish Neonatology Society guidelines.
  • NICU admission, antibiotic use, and hospitalization duration were recalculated for each guideline.

Main Results:

  • The 2023 guideline increased eligible infants for antibiotics from 25.0% to 72.4%.
  • This led to a significant rise in NICU admissions (67.3% to 91.5%) and median antibiotic duration (0 to 2 days).
  • No cases of early-onset neonatal sepsis (EONS) were detected in newly eligible infants.

Conclusions:

  • Raising the gestational age threshold to <35 weeks increases antibiotic exposure and NICU utilization without enhancing EONS detection.
  • There is a need for improved risk-stratification strategies for preterm infants.
  • Unnecessary antibiotic use raises concerns for antimicrobial stewardship and healthcare burden.
Abstract

Keywords:
antimicrobial stewardshipearly-onset neonatal sepsisempirical antibiotic usegestational age thresholdlate preterm infantsrisk stratification

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