Objective To characterize the relationship between the duration of antibiotic administration during the first week of life and subsequent growth velocity during hospitalization. Study Design This was a retrospective study comparing the inhospital growth of infants born between 30 and 326/7 weeks' gestational age (GA) admitted to the Montefiore Weiler and Wakefield neonatal intensive care units between January 2009 and December 2015. Antibiotic duration during the first week of life was classified as no antibiotics, <5 days of antibiotics, or ≥5 days of antibiotics. Differences between discharge and birth weight Z-scores were compared between the three groups using analysis of variance. Results Of the infants, 87% received antibiotics during the first week of life, with 16% of infants completing ≥5 days. Compared with infants receiving ≤ 5 days of antibiotics, infants treated with ≥5 days had a lower GA, lower Apgar scores, more invasive respiratory support, longer duration of total parenteral nutrition, delayed initiation of enteral feeding, and a higher weight Z-score on admission and discharge (p < 0.05). However, there was no distinction in growth between the three groups assessed by the difference between admission and discharge weight Z-scores (p = 0.64), growth velocity (gram/kilogram/day) (p = 0.104), or an exponential growth velocity outcome (p = 0.423). Conclusion Early antibiotic exposure was not associated with increased growth velocity between birth and discharge. Our study was limited by its retrospective nature and lack of follow-up data postdischarge.

Context: Necrotizing enterocolitis (NEC) remains one of the most common causes of morbidity and mortality for premature infants in the neonatal intensive care unit (NICU). Many theories concerning its pathophysiology and inciting factors have been suggested but progression in preventing the onset of NEC has been minimal. While this article highlights the pathophysiology, management, and outcomes of NEC, it mainly serves as a narrative review to discuss the emerging methods of treatment and prevention.Evidence Acquisition: A literature search was done using Medline/Pub Med, Cochrane Database of Systematic Reviews via Ovid, and CINAHL Complete with focus on articles published between 2000 and 2016. Searched terms included the following: necrotizing enterocolitis, pathogenesis, prevention, management, breast milk, formula, probiotics, prebiotics, and treatment. Results:Intestinal barrier dysfunction, hypoxic ischemic injury, receipt of packed red blood cells, immature intestinal immunity and alterations of the gut microbiome of the premature infant were reviewed factors that have been studied related to the pathophysiology of NEC. The presentation, staging and management remain relatively unchanged in the last few decades, though there have been a few studies evaluating different surgical options, various antibacterial regimen, and recently use of moderate hypothermia and amniotic fluid stem cells to treat NEC. Use of breast milk, use of pre-, pro-and postbiotics show promise in the prevention of NEC.Conclusions: NEC is a likely multifactorial illness of the gastrointestinal tract affecting mostly premature infants. Recent studies have focused on preventative strategies, with promise in pre-, pro-and postbiotics; however continued research is imperative.

To determine the frequency of cardiorespiratory events following routine exams for retinopathy of prematurity (ROP). This is a retrospective review of 79 premature infants in the neonatal intensive care unit at the University of Rochester Medical Center. The baseline for each infant (mean cardiorespiratory events in the 72 hours before the exam) was compared with the number of cardiorespiratory events during the subsequent 24 hours using generalized estimating equation and the Mantel-Haenszel chi-square test to determine if there was an association between cardiorespiratory events and potential risk factors. Approximately 19 to 25% of infants experienced an increase in cardiorespiratory events in the 24 hours following their eye exams. These newborns were generally of a younger gestational age and lower birthweight. The frequency of cardiorespiratory events following routine ROP exams is similar to that following routine immunizations in this population. Thus, in infants being continuously monitored during the 24 hours after the exam, alterations in medical care in the absence of other clinical signs suggestive of sepsis or clinical deterioration may not be required, limiting unnecessary antibiotic exposure, prolonged caffeine administration, unwarranted gastroesophageal reflux treatment, and undue family stress.

We present a previously healthy 16-year-old male with ehrlichiosis-induced aseptic meningitis and subsequent second-degree heart block.

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