Antibiotic stewardship in perinatal and neonatal care

Ramasethu, Jayashree; Kawakita, Tetsuya

doi:10.1016/j.siny.2017.07.001

Cited by 68 publications

(63 citation statements)

References 45 publications

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“…21 Studies looking that the effectiveness of ASPs in the NICU, the effect of interprovider variability on adherence to ASP guidelines, and the potential adverse outcomes when there is deviation from ASP guidelines demonstrate the importance of being thoughtful when deciding whether to give antibiotic therapy to neonates. [22][23][24] Although the effects of early antibiotic use in premature infants on growth and metabolic changes have yet to be fully elucidated, this study explores another reason to be judicious with the administration of antibiotics in neonates. Future steps involve a prospective study with a larger sample size, postdischarge follow-up, and infants of lower GA. Metabolomic analysis of urine and stool samples may help determine functional changes from antibiotic exposure.…”

Section: Discussionmentioning

confidence: 99%

Relationship between Early Antibiotic Exposure and Short-Term Growth Velocity in Premature Neonates

et al. 2018

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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.

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Section: Discussionmentioning

confidence: 99%

Relationship between Early Antibiotic Exposure and Short-Term Growth Velocity in Premature Neonates

et al. 2018

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“…Studies have correlated early antibiotic exposure in neonates to alteration of the neonatal intestinal microbiome, which may lead to long-term adverse effects such as altered physical growth, poor neurodevelopment and immune diseases in childhood; it is also associated with increased rates of necrotising enterocolitis, late-onset sepsis, secondary infection of conditional pathogenic bacteria or fungal infection and increased mortality in premature infants. 19,20 There is a need for a simple and efficient predictor for identifying non-infected neonates in the first few hours of life, so they can be protected from unnecessary antibiotic exposure and from the spread of multidrug-resistant organisms. The EOS risk calculator has already been used in practice in some neonatal centres in Western countries and has been validated as a tool to reduce unnecessary antibiotic exposure in previous studies.…”

Section: Discussionmentioning

confidence: 99%

Efficacy and safety of applying a neonatal early‐onset sepsis risk calculator in China

Chen

Liu

et al. 2019

J Paediatrics Child Health

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Aim To evaluate and compare the performance of the early‐onset sepsis (EOS) risk calculator with procalcitonin (PCT), complete blood count (CBC) and C‐reactive protein (CRP) for predicting neonatal EOS. Methods This was a retrospective case–control study of neonates who were ≥34 weeks of gestation and ≤12 h of age at admission to our hospital between January 2017 and December 2018. Neonates with strictly defined EOS and those without evidence of infection were included in this study. We reviewed and collected the laboratory data and medical charts of the included neonates. The EOS risk scores for all neonates were calculated using the EOS risk calculator, and the results were analysed and compared with blood biomarkers. Results A total of 501 neonates, including 353 infected and 148 uninfected infants, met the inclusion criteria for the study. Comparing these predictors, PCT had the best predictive value (sensitivity: 87.5%, specificity: 95.5%), closely followed by the EOS risk calculator (sensitivity: 81.16%, specificity: 93.92%). Multivariate logistic regression found that risk scores calculated by the EOS risk calculator had strong associations with EOS as an independent risk factor (odds ratio: 57.37, P < 0.05). The combination of the EOS risk calculator, PCT, CBC and CRP could increase the predictive value of the model and reach an area under the receiver operating characteristic curve of 0.987 for predicting EOS. Conclusions In this pilot study, applying the EOS calculator in China, the EOS risk calculator and PCT showed good predictive value compared to CBC and CRP. Risk scores from the EOS risk calculator strongly correlated with EOS, and the EOS risk calculator offered increased predictive value when used in combination with blood biomarkers.

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“…In recent years there has been greater awareness regarding the responsible use of antibiotics, especially in VLBW neonates 23 . As a consequence, different strategies have been developed in order to reduce the indication and duration of these treatments.…”

Section: Discussionmentioning

confidence: 99%