Majority of premature infants still exposed to early antibiotics

May 25, 2018

BottomLine: Most premature infants, who are at risk for sepsis but who may not have a culture confirmation of infection, continue to receive early antibiotics in the first few days of life, a finding that suggests neonatal antibiotic stewardship efforts are needed to help clinicians identify infants at lowest risk for infection to avoid unnecessary antibiotic exposure.

Why The Research Is Interesting: Antibiotics are commonly used in neonatal intensive care units. Empirical (early, without culture confirmation) antibiotic therapy is frequently given to very low-birth-weight (less than 1,500 grams) infants when they are born because of their risk for sepsis combined with the clinical instability of premature infants. Previous studies suggest these antibiotics given to protect infants also are associated with potential risks.

Who and When: 40,364 very low-birth-weight infants, including 12,947 extremely low-birth-weight infants (less than 1,000 grams), who survived for at least a day at 297 hospitals between 2009-2015; the study used an administrative database

What and When (Study Measures): Antibiotics initiated within the first 3 days of age and subsequent antibiotics given for more than five days (exposures); trends over time in early antibiotic initiation and duration from 2009-2015.

How (Study Design): This was an observational study. Researchers were not intervening for purposes of the study and they cannot control natural differences that could explain study findings.

Authors: Dustin D. Flannery, D.O., of Children's Hospital of Philadelphia, and coauthors

Results: The majority of premature infants had early antibiotic initiation (78.6 percent of very low-birth-weight infants and 87 percent of extremely low-birth-weight infants) and rates of initiation of empirical early antibiotic therapy didn't change over time.

Study Limitations: The database didn't have information to compare the severity of infants' early illness or information to identify infants with culture-confirmed infections; hospitals in the southern United States were over represented.

Related Material: The invited commentary, "Avoiding Unnecessary Antibiotic Exposure in Premature Infants: Understanding When (Not) to Start and When to Stop," by Matthew J. Bizzarro, M.D., of Yale University School of Medicine, New Haven, Connecticut, als0 is available on the For The Media website.

For more details and to read the full study, please visit the For The Media website.

(doi:10.1001/jamnetworkopen.2018.0164)

Editor's Note: The article contains conflict of interest and funding support disclosures. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.
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