Association of Placental Pathology and antibiotic exposure after birth with the Severity of Necrotizing Enterocolitis in Preterm infants: A Case-Control Study.

IF 1.5 4区医学 Q3 OBSTETRICS & GYNECOLOGY

American journal of perinatology Pub Date : 2025-07-23 DOI:10.1055/a-2663-5723

Parvesh Mohan Garg, Robin Riddick, Md Yusuf Ansari, Aubrey Rebentisch, Avinash K Shetty, Kristin Adams, William Hillegass, Padma Parvesh Garg

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引用次数: 0

Abstract

Objective: To assess the relationship between placental lesions, antibiotic exposure duration, and necrotizing enterocolitis (NEC) severity in preterm infants.

Methods: In this single-center, case-control study, 107 infants with NEC and 130 controls were grouped by antibiotic exposure after birth: ≤3 days or >3 days.

Results: Of 212 infants, 103 (48.5%) received antibiotics for ≤3 days, while 109 (51.5%) received antibiotics for >3 days. Multivariate regression analysis demonstrated that prolonged antibiotic duration (>3 days vs. ≤3 days) was significantly associated with increased severity of NEC, with adjusted odds ratios (aOR) of 2.65 (95% CI: 1.36-5.16; p=0.004) for medical NEC and 3.36 (95% CI: 1.56-7.23; p=0.002) for surgical NEC. However, prolonged antibiotic duration was not significantly associated with overall mortality (aOR 1.16, 95% CI: 0.58-2.34; p=0.7). Among infants diagnosed with NEC (n=97), antibiotic duration >3 days significantly increased the odds of mortality (aOR 7.34, 95% CI: 1.94-48.3; p=0.011) but was not significantly associated with NEC severity (aOR 1.20, 95% CI: 0.49-2.94; p=0.7). Among 64 infants with acute histologic chorioamnionitis, 37 (58%) received antibiotics >3 days. Longer antibiotic exposure was linked to higher risks of medical NEC (79% vs. 38%; p=0.021) and surgical NEC (62% vs. 38%; p=0.021) compared to shorter exposure. In 134 infants with maternal vascular malperfusion, prolonged antibiotics were also associated with increased risks for medical (60% vs. 36%; p=0.007) and surgical NEC (67% vs. 36%; p=0.007). Concordance between clinical and pathologic chorioamnionitis was moderate (AC₁ 0.60), while agreement for PIH versus maternal vascular malperfusion was minimal (AC₁ 0.07).

Conclusion: Prolonged antibiotic exposure (>3 days) in infants with chorioamnionitis or maternal vascular malperfusion is most likely associated with increased NEC severity. Limiting antibiotic duration may reduce severe NEC risk in preterm infants.

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出生后胎盘病理和抗生素暴露与早产儿坏死性小肠结肠炎严重程度的关系：一项病例对照研究。

目的：探讨早产儿胎盘病变、抗生素暴露时间与坏死性小肠结肠炎（NEC）严重程度的关系。方法：在这项单中心病例对照研究中，107例NEC患儿和130例对照组按出生后抗生素暴露情况分为≤3天和≤3天。结果：212例患儿中，103例（48.5%）使用抗生素≤3 d， 109例（51.5%）使用抗生素≤3 d。多因素回归分析显示，延长抗生素使用时间（3天vs.≤3天）与NEC严重程度增加显著相关，调整优势比（aOR）为2.65 (95% CI: 1.36-5.16；p=0.004)，为3.36 (95% CI: 1.56-7.23；p=0.002)。然而，延长抗生素使用时间与总死亡率无显著相关性(aOR 1.16, 95% CI: 0.58-2.34；p = 0.7)。在被诊断为NEC的婴儿中（n=97），抗生素持续时间3天显著增加死亡几率(aOR 7.34, 95% CI: 1.94-48.3；p=0.011)，但与NEC严重程度无显著相关性(aOR 1.20, 95% CI: 0.49-2.94；p = 0.7)。64例急性组织学绒毛膜羊膜炎患儿中，37例（58%）接受抗生素治疗3天。更长时间的抗生素暴露与更高的医学NEC风险相关(79% vs 38%；p=0.021)和手术NEC (62% vs. 38%；P =0.021)。在134名母亲血管灌注不良的婴儿中，长期使用抗生素也与医疗风险增加相关(60%对36%；p=0.007)和手术NEC (67% vs 36%；p = 0.007)。临床和病理性绒毛膜羊膜炎之间的一致性是中等的（AC₁0.60），而PIH与母体血管灌注不良的一致性是最小的（AC₁0.07）。结论：绒毛膜羊膜炎或母体血管灌注不良的婴儿长时间抗生素暴露（>3天）最有可能与NEC严重程度增加有关。限制抗生素持续时间可以降低早产儿严重NEC的风险。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

American journal of perinatology 医学-妇产科学

CiteScore

5.90

自引率

0.00%

发文量

302

审稿时长

4-8 weeks

期刊介绍： The American Journal of Perinatology is an international, peer-reviewed, and indexed journal publishing 14 issues a year dealing with original research and topical reviews. It is the definitive forum for specialists in obstetrics, neonatology, perinatology, and maternal/fetal medicine, with emphasis on bridging the different fields. The focus is primarily on clinical and translational research, clinical and technical advances in diagnosis, monitoring, and treatment as well as evidence-based reviews. Topics of interest include epidemiology, diagnosis, prevention, and management of maternal, fetal, and neonatal diseases. Manuscripts on new technology, NICU set-ups, and nursing topics are published to provide a broad survey of important issues in this field. All articles undergo rigorous peer review, with web-based submission, expedited turn-around, and availability of electronic publication. The American Journal of Perinatology is accompanied by AJP Reports - an Open Access journal for case reports in neonatology and maternal/fetal medicine.