TY - JOUR
T1 - Early Use of Antibiotics Is Associated with a Lower Incidence of Necrotizing Enterocolitis in Preterm, Very Low Birth Weight Infants
T2 - The NEOMUNE-NeoNutriNet Cohort Study
AU - Li, Yanqi
AU - Shen, René Liang
AU - Ayede, Adejumoke I
AU - Berrington, Janet
AU - Bloomfield, Frank H
AU - Busari, Olubunmi O
AU - Cormack, Barbara E
AU - Embleton, Nicholas D
AU - van Goudoever, Johannes B
AU - Greisen, Gorm
AU - He, Zhongqian
AU - Huang, Yan
AU - Li, Xiaodong
AU - Lin, Hung-Chih
AU - Mei, Jiaping
AU - Meier, Paula P
AU - Nie, Chuan
AU - Patel, Aloka L
AU - Sangild, Per T
AU - Skeath, Thomas
AU - Simmer, Karen
AU - Uhlenfeldt, Signe
AU - de Waard, Marita
AU - Ye, Sufen
AU - Ye, Xuqiang
AU - Zhang, Chunyi
AU - Zhu, Yanna
AU - Zhou, Ping
N1 - Crown Copyright © 2020. Published by Elsevier Inc. All rights reserved.
PY - 2020/12
Y1 - 2020/12
N2 - OBJECTIVE: To determine whether commencement of antibiotics within 3 postnatal days in preterm, very low birth weight (VLBW; ≤1500 g) infants is associated with the development of necrotizing enterocolitis (NEC).STUDY DESIGN: Preplanned statistical analyses were done to study the association between early antibiotic treatment and later NEC development, using the NEOMUNE-NeoNutriNet cohort of VLBW infants from 13 neonatal intensive care units (NICUs) in 5 continents (n = 2831). NEC incidence was compared between infants who received early antibiotics and those who did not, with statistical adjustments for NICU, gestational age, birth weight, sex, delivery mode, antenatal steroid use, Apgar score, and type and initiation of enteral nutrition.RESULTS: The incidence of NEC was 9.0% in the group of infants who did not receive early antibiotics (n = 269), compared with 3.9% in those who did receive early antibiotics (n = 2562). The incidence remained lower in the early antibiotic group after stepwise statistical adjustments for NICU (OR, 0.57; 95% CI, 0.35-0.94, P < .05) and other potential confounders (OR, 0.25; 95% CI, 0.12-0.47; P < .0001).CONCLUSIONS: In this large international cohort of preterm VLBW infants, a small proportion of infants did not receive antibiotics just after birth, and these infants had a higher incidence of NEC. It is important to better understand the role of such variables as time, type, and duration of antibiotic treatment on NEC incidence, immune development, gut colonization, and antibiotic resistance in the NICU.
AB - OBJECTIVE: To determine whether commencement of antibiotics within 3 postnatal days in preterm, very low birth weight (VLBW; ≤1500 g) infants is associated with the development of necrotizing enterocolitis (NEC).STUDY DESIGN: Preplanned statistical analyses were done to study the association between early antibiotic treatment and later NEC development, using the NEOMUNE-NeoNutriNet cohort of VLBW infants from 13 neonatal intensive care units (NICUs) in 5 continents (n = 2831). NEC incidence was compared between infants who received early antibiotics and those who did not, with statistical adjustments for NICU, gestational age, birth weight, sex, delivery mode, antenatal steroid use, Apgar score, and type and initiation of enteral nutrition.RESULTS: The incidence of NEC was 9.0% in the group of infants who did not receive early antibiotics (n = 269), compared with 3.9% in those who did receive early antibiotics (n = 2562). The incidence remained lower in the early antibiotic group after stepwise statistical adjustments for NICU (OR, 0.57; 95% CI, 0.35-0.94, P < .05) and other potential confounders (OR, 0.25; 95% CI, 0.12-0.47; P < .0001).CONCLUSIONS: In this large international cohort of preterm VLBW infants, a small proportion of infants did not receive antibiotics just after birth, and these infants had a higher incidence of NEC. It is important to better understand the role of such variables as time, type, and duration of antibiotic treatment on NEC incidence, immune development, gut colonization, and antibiotic resistance in the NICU.
KW - Anti-Bacterial Agents/administration & dosage
KW - Case-Control Studies
KW - Cohort Studies
KW - Databases, Factual
KW - Enterocolitis, Necrotizing/epidemiology
KW - Female
KW - Humans
KW - Incidence
KW - Infant, Newborn
KW - Infant, Newborn, Diseases/epidemiology
KW - Infant, Premature
KW - Infant, Very Low Birth Weight
KW - Intensive Care Units, Neonatal/statistics & numerical data
KW - Male
U2 - 10.1016/j.jpeds.2020.06.032
DO - 10.1016/j.jpeds.2020.06.032
M3 - Journal article
C2 - 32553865
SN - 0022-3476
VL - 227
SP - 128-134.e2
JO - The Journal of pediatrics
JF - The Journal of pediatrics
ER -