Early antibiotic exposure and necrotizing enterocolitis among preterm infants < 34 weeks' gestation.

Abstract

Background: To investigate whether use, duration, and types of early antibiotics were associated with the risk of necrotizing enterocolitis (NEC) among preterm infants born at <34 weeks' gestation.

Methods: This multicenter prospective cohort study included all infants with gestational age <34 weeks and admitted to neonatal intensive care units across China. Early antibiotic exposure was defined as the antibiotic treatment initiated within the first three postnatal days. The short-term outcomes included death, NEC, death and/or NEC. Propensity score matching was performed to generate matched cohorts. The impacts of early antibiotics exposure on the outcomes were evaluated by univariate and multivariate logistic regression models.

Results: Among 24,926 eligible infants, 20164 (80.9%) received early antibiotics. After matching, early antibiotics exposure was not significantly associated with the death and/or NEC (adjusted OR, 0.93; 95%CI, 0.72-1.21), NEC (adjusted OR, 0.81; 95% CI, 0.60 -1.10) or death (adjusted OR, 1.42; 95% CI, 0.90-2.25). However, prolonged antibiotic treatment (adjusted OR, 2.95; 95% CI, 1.67-5.22), especially broad-spectrum antibiotics exposure (adjusted OR, 5.09; 95% CI, 1.84-14.10), was independently associated with death.

Conclusion: While early antibiotics exposure was not associated with the risks of NEC, prolonged antibiotic duration, especially broad-spectrum antibiotics, was associated with a higher mortality.

Impact: This multicenter cohort study sheds light on whether use, duration, and types of early antibiotics were associated with the risk of necrotizing enterocolitis among preterm infants <34 weeks of gestation. In preterm infants, early antibiotics exposure was not significantly associated with the risks of death and/or NEC. However, prolonged antibiotic duration, especially broad-spectrum antibiotics, was associated with a higher mortality. Our study emphasizes the importance of neonatal antimicrobial stewardship in improving the prognosis of premature infants.