Increased antibiotic exposure in early life is associated with adverse outcomes in very low birth weight infants

Abstract

Background: The use of antibiotics in the early lives of premature infants may alter the microbiota and influence their clinical outcomes. However, whether the administration of probiotics can influence these outcomes remains unknown. In our study, probiotics were routinely administered unless contraindicated. We explored whether increased antibiotic exposure with the routine use of probiotics was associated with necrotizing enterocolitis (NEC) or bronchopulmonary dysplasia (BPD). Methods: A retrospective cohort study was conducted, enrolling very low birth weight (VLBW) infants admitted between January 1, 2016, and March 31, 2020, to a medical center. Days of antibiotic exposure in the first 14 days of life were recorded. The primary outcomes were NEC and BPD. Adjusted odds ratios (aORs) and 95% confidence intervals (CIs) were calculated using multivariable regression analyses to assess risk factors. Results: Of 185 VLBW infants admitted to the medical center, 132 met the inclusion criteria. Each additional day of antibiotic treatment was associated with increased odds of NEC (aOR, 1.278; 95% CI, 1.025-1.593) and BPD (aOR, 1.630; 95% CI, 1.233-2.156). The association remained in the NEC analysis after adjustment for probiotic use. Conclusion: Increased antibiotic exposure in the early lives of VLBW infants was associated with increased risks of NEC and BPD. The probiotics did not influence the outcomes. Our findings suggest that clinicians should be alerted to the adverse outcomes of antibiotic use in infants with VLBWs.

Prolonged antibiotic therapy increased necrotizing enterocolitis in very low birth weight infants without culture-proven sepsis

“…Raba et al also found that the cumulative total number of days of antibiotic exposure was associated with an increased risk of developing NEC ( 5 ). Chen et al included 132 VLBW infants and found each additional day of antibiotic treatment was associated with increased odds of NEC (OR, 1.278; 95% CI, 1.025–1.593) ( 14 ). The findings of our study agreed with the results of these studies which suggested that the A/H ratio before NEC could increase the risk of NEC.…”

Is antibiotic exposure associated with an increased risk of developing necrotizing enterocolitis and bronchopulmonary dysplasia in very low birth weight infants?

“…We have read the article entitled “Increased antibiotics exposure in early life is associated with adverse outcomes in very low birth weight infants.” published in the September issue of the Journal of the Chinese Medical Association with interest. 1 Chen et al 1 attempted to explore whether increased antibiotics exposure with the routine use of probiotics was associated with necrotizing enterocolitis (NEC) or bronchopulmonary dysplasia (BPD). The authors found that there was no significant difference of occurrence of NEC or BPD in very low birth weight (VLBW) infants, regardless probiotics were routinely used or not.…”

“…The authors found that there was no significant difference of occurrence of NEC or BPD in very low birth weight (VLBW) infants, regardless probiotics were routinely used or not. 1 Additionally, they identified that increased antibiotic exposure of VLBW infants was associated with increased risks of NEC and BPD with an adjusted odd ratio of 1.278 (95% confidence interval [CI], 1.025-1.593) and 1.630 (95% CI, 1.233-2.156), respectively. 1 We appreciated the authors’ excellent contribution to an improved care of these VLBW infants vulnerable to injuries due to prematurity, 2,3 but there are some questions that need clarification.…”

When more can lose more: Comments to the long-term use of prophylactic antibiotics for very low birth weight infant resulting in the adverse outcomes

“…12 A recent publication from the Journal of the Chinese Medical Association entitled "Increased antibiotics exposure in early life is associated with adverse outcomes in very low birth weight infants" has focused on the worse outcomes about the use of antibiotics in these VLBW infants. 13 The authors found that increased antibiotic exposure to the VLBW infants was associated with increased risks of necrotizing enterocolitis (NEC) and bronchopulmonary dysplasia (BPD), and the longer duration of antibiotics exposure further augmented the existed risk of NEC and BPD with adjusted odds ratio (aOR) of 1.278 and 1.630, respectively, in antibiotic exposure per day. 13 Although their findings may be informative, some uncertainties are worthy of further discussion, since it may significantly influence our decision in the management of VLBW infants in the future.…”

“…13 The authors found that increased antibiotic exposure to the VLBW infants was associated with increased risks of necrotizing enterocolitis (NEC) and bronchopulmonary dysplasia (BPD), and the longer duration of antibiotics exposure further augmented the existed risk of NEC and BPD with adjusted odds ratio (aOR) of 1.278 and 1.630, respectively, in antibiotic exposure per day. 13 Although their findings may be informative, some uncertainties are worthy of further discussion, since it may significantly influence our decision in the management of VLBW infants in the future.…”