Prolonged neonatal antibiotic therapy decreases yet remains associated with adverse outcomes
BALTIMORE — Although overall prolonged exposure to antibiotics decreased among extremely low birth weight patients over time, exposure varied significantly between neonatal centers and continues to be associated with mortality, according to research data presented at the Pediatric Academic Societies Meeting.
“While neonatologists often prescribe a prolonged initial course of antibiotics to premature infants due to fear of early-onset sepsis, it has been shown previously that exposure to a prolonged course of antibiotics was associated with increased risk of death, necrotizing enterocolitis and late-onset sepsis,” Rachel G. Greenberg, MD, a fellow in training at Duke University Medical Center, told Infectious Diseases in Children. “The goal of this study was to determine whether the prevalence of prolonged initial antibiotic exposure in premature infants has changed over time and whether it remains associated with negative outcomes.”
The researchers studied 5,867 extremely low birth weight infants born at 22 to 28 weeks’ gestation from 13 neonatal centers between 2008 and 2014. Participants were included if they weighed between 401 g and 1,000 g, survived more than 5 days and had sterile blood and cerebrospinal fluid within the first 3 days of life.
Study results showed that overall prolonged exposure to antibiotics among the cohort decreased from 50% in 2008 to 36% in 2014. Forty-five percent of patients received this therapy, with prevalence varying from 30% to 69% between centers.
Greenberg and colleagues also found that prolonged initial antibiotic therapy remained associated with severe adverse outcomes, including death (adjusted OR = 1.2; 95% CI, 1.02-1.42). No significant associations, however, were observed between the therapy and necrotizing enterocolitis or with late-onset sepsis, or between a composite outcome of death or necrotizing enterocolitis.
“These findings demonstrate that centers have been able to change their practice over time in response to the available data and that there is a continued need for emphasis on antibiotic stewardship in the neonatal intensive care unit,” Greenberg said. – by David Costill
Greenberg RG, et al. Abstract 2720A.5. Presented at: Pediatric Academic Societies Meeting; April 30-May 3, 2016; Baltimore.
Disclosure: The researchers report no relevant financial disclosures.