Duration of Initial Empirical Antibiotic Therapy and Outcomes in Very Low Birth Weight Infants

Ting, Joseph; Roberts, Ashley; Sherlock, Rebecca; Ojah, Cecil; Cieslak, Zenon; Dunn, Michael; Barrington, Keith J.; Yoon, Eugene W.; Shah, Prakesh S.

doi:10.1542/peds.2018-2286

Cited by 134 publications

(133 citation statements)

References 31 publications

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“…41 In contrast to the aforementioned perception, antibiotic courses as brief as 4 days administered to very low and extremely low birth weight infants during the first week of life have been associated with a greater likelihood of adverse outcomes including chronic lung disease, necrotizing enterocolitis, invasive candidiasis and late-onset sepsis (possibly due to antibiotic-induced alterations in the neonatal intestinal microbiome). 36,37,42,43 Per Cantey and Patel, 35 "Neonatologists may be more receptive to implementing changes in their practice if advocated by a well-respected peer rather than ID doctors or pharmacists." Fortunately, increasing numbers of neonatologists are answering the call to advocate for neonatal AS.…”

Section: Hospitalistsmentioning

confidence: 99%

<p>Pediatric Antimicrobial Stewardship Programs: Current Perspectives</p>

Klatte

2020

PHMT

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With the rapid growth of the field of pediatric antimicrobial stewardship, there has been a marked increase in the establishment of programs dedicated to this specialty. Shared objectives of all pediatric antimicrobial stewardship programs (ASPs) include optimization of antibiotic use and improvement in clinical outcomes for children, while certain core operational strategies and metrics used to measure program effectiveness are typically utilized by pediatric ASPs. Antimicrobial stewardship is the responsibility of every individual who prescribes, dispenses, and administers antibiotics to children, and pediatric ASP principles are rooted in collaboration and cooperation. Pediatric ASPs are uniquely suited to meet the needs of the local populations they serve and the environments within which they practice while also fostering an awareness of the interconnected global nature of pediatric stewardship. As such, pediatric ASPs are well positioned to confront the evolving challenges of antimicrobial overuse and resistance.

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Section: Hospitalistsmentioning

confidence: 99%

<p>Pediatric Antimicrobial Stewardship Programs: Current Perspectives</p>

Klatte

2020

PHMT

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“…The previously described negative association of prolonged antibiotic use and increased risk of NEC, late-onset sepsis, BPD, retinopathy of prematurity, invasive fungal disease, neurodevelopmental impairment, and death likely override any potential bene t with improved weight gain in the NICU and beyond. (33)(34)(35)(36)(37)(38)(39)…”

Section: Resultsmentioning

confidence: 99%

Antibiotic Exposure and Growth Patterns in Preterm, Very Low Birth Weight Infants

Pyle

Cantey

Brown

et al. 2020

Preprint

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Background. Antibiotic exposure in term infants has been associated with later obesity. Premature, very-low-birth-weight (birth weight ≤1500 grams) infants in the neonatal intensive care unit frequently are exposed to antibiotics. Our hypothesis was that in preterm infants, there is a positive linear and dose-dependent relationship between antibiotic exposure and growth from birth through 12 months’ corrected age.Methods. Retrospective analysis of prospectively collected data of all antibiotic use among inborn, preterm (≤32 weeks’ gestation), very-low-birth-weight infants admitted to the neonatal intensive care unit at Parkland Memorial Hospital and followed in the Low Birth Weight Clinic at Children’s Medical Center, Dallas, TX. Antibiotic use was quantified by days of therapy which was compared with weight and length parameters at birth, 36 weeks’ postmenstrual age, and 2, 4, 6, and 12 months’ corrected age. The change in weight and length z-scores from birth to all subsequent age points was calculated. Stepwise multivariate regression analysis was performed for weight, length, and weight-for-length delta z-scores at each age point. Results. During the 18-month study, 161 infants received a median of 11 (IQR, 5.5-19.5) antibiotic days of therapy which was not associated with weight or length delta z-scores from birth through 12 months’ corrected age.Conclusion. Association of prolonged antibiotic use and neonatal morbidities and mortality may override the potential association with increased weight gain in the NICU and beyond.

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“…Antibiotic use in early life is known to disturb microbiota development in preterm infants [ 19 ]. Besides, reduction of unnecessary antibiotic treatment is of importance, as each day of prolonged early use is associated with an increased risk for late-onset sepsis (LOS), NEC or death [ 20 ]. However, reducing antibiotic use in daily NICU practice is still challenging.…”

Section: Discussionmentioning

confidence: 99%

Introduction of less invasive surfactant administration (LISA), impact on diagnostic and therapeutic procedures in early life: a historical cohort study

et al. 2020

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Background In preterm infants with Respiratory Distress Syndrome (RDS), Less Invasive Surfactant Administration (LISA) has been established to reduce the need of mechanical ventilation and might improve survival rates without bronchopulmonary dysplasia. The aim of this study was to investigate whether NICU care has changed after introduction of less invasive surfactant administration (LISA), with regard to diagnostic and therapeutic procedures in the first week of life. Methods Infants with gestational age < 32 weeks who received surfactant by LISA (June 2014 – December 2017, n = 169) were retrospectively compared to infants who received surfactant after intubation (January 2012 – May 2014, n = 155). Local protocols on indication for surfactant, early onset sepsis, blood transfusions and enteral feeding did not change between both study periods. Besides, as secondary outcome complications of prematurity were compared. Data was collected from electronic patient files and compared by univariate analysis through Students T-test, Mann Whitney-U test, Pearson Chi-Square test or Linear by Linear Association. Results All baseline characteristics of both groups were comparable. Compared to controls, LISA patients received a higher total surfactant dose (208 vs.160 mg/kg; p < 0.001), required redosing more frequently (32.5% vs. 21.3%; p = 0.023), but needed less mechanical ventilation (35.5% vs. 76.8%; p < 0.001). After LISA, infants underwent fewer X-rays (1.0 vs. 3.0, p < 0.001), blood gas examinations (3.0 vs. 5.0, p < 0.001), less inotropic drugs (9.5% vs. 18.1%; p = 0.024), blood transfusions (24.9% vs. 41.9%, p = 0.003) and had shorter duration of antibiotic therapy for suspected early onset sepsis (3.0 vs. 5.0 days, p < 0.001). Moreover, enteral feeding was advanced faster (120 vs. 100 mL/kg/d, p = 0.048) at day seven. There were no differences in complications of prematurity. Conclusion The introduction of LISA is associated with significantly fewer diagnostic and therapeutic procedures in the first week of life, which emphasizes the beneficial effects of LISA.

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Duration of Initial Empirical Antibiotic Therapy and Outcomes in Very Low Birth Weight Infants

Cited by 134 publications

References 31 publications

<p>Pediatric Antimicrobial Stewardship Programs: Current Perspectives</p>

<p>Pediatric Antimicrobial Stewardship Programs: Current Perspectives</p>

Antibiotic Exposure and Growth Patterns in Preterm, Very Low Birth Weight Infants

Introduction of less invasive surfactant administration (LISA), impact on diagnostic and therapeutic procedures in early life: a historical cohort study

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