Impact of early life antibiotic exposure on the preschool developmental status: a nationwide population-based study.

Abstract

Objective: Growing concerns exist about the potential adverse effects of early antibiotic exposure on neurodevelopmental outcomes. However, large-scale studies exploring these implications in early childhood are rare.

Design: A nationwide, population-based retrospective cohort study using data from the Korean National Health Insurance System and the National Health Screening Program for Infants and Children (NHSPIC) between 2015 and 2022.

Patients: A total of 1 848 841 children who participated in the NHSPIC at both 4-6 months and 54-60 months of age were included.

Interventions: Antibiotic exposure under 90 days old.

Main outcome measures: Developmental delays in preschool-aged children assessed by the Korean Developmental Screening Test at 54-60 month of age.

Results: Among the 1 848 841 children assessed, 23% experienced antibiotic exposure within the first 3 months of life. Early use of antibiotics was linked to a slightly elevated risk of developmental delays at a median age of 4.94 years (OR 1.03, 95% CI 1.00 to 1.17), particularly affecting gross motor (OR 1.08, 95% CI 1.04 to 1.13), fine motor (OR 1.09, 95% CI 1.05 to 1.13), cognition (OR 1.08, 95% CI 1.04 to 1.13) and communication (OR 1.08, 95% CI 1.04 to 1.12). A dose-response relationship was also observed, with longer durations of antibiotic exposure associated with an increased risk of developmental delays.

Conclusions: Exposure to antibiotics in infants under 90 days old may be associated with a modest increase in the risk of global developmental delays, especially in motor skills, cognitive functions and communication abilities. Careful consideration is necessary when prescribing antibiotics to this age group.