Prolonged Antibiotic Use in Very Preterm Infants Linked to Increased Mortality Risk: JAMA

A new study published in the Journal of the American Medical Association found that very preterm infants (VPIs) who were at low risk for early-onset sepsis (EOS) and exposed to prolonged or broad-spectrum antibiotics were more likely to develop moderate to severe bronchopulmonary dysplasia (BPD).

Antibiotic overuse in preterm newborns with low risk of early-onset sepsis is linked to higher death and morbidity rates. Thereby, Wei Shi and colleagues undertook this study to assess the relationship between varied durations and kinds of early antibiotic exposure and the occurrence of BPD in VPIs at a low-risk of EOS.

This nationwide multicenter cohort research used data from the Chinese Neonatal Network (CHNN) that gathered data prospectively from January 1, 2019 to December 31, 2021.The cohort included VPIs less than 32 weeks of gestational age or with a birth weight of less than 1500 grams. These infants were further categorized as low risk for EOS based on criteria such as cesarean delivery, absence of labor or rupture of membranes, and no clinical evidence of chorioamnionitis.

The key findings of this study were:

• Of the 27,176 VPIs included in the CHNN throughout the research period, a total of 6510 were classed as low risk for EOS.
• Among them, 1324 (20.3%) faced no antibiotic exposure, 1134 (17.4%) had 1 to 4 days of antibiotic treatment and 4052 (62.2%) received 5 to 7 days of antibiotic therapy.
• Of the 5186 VPIs who got antibiotics, 4098 (79.0%) infants got broad-spectrum antibiotics, 888 (17.1%) infants got narrow-spectrum antibiotics and 200 (3.9%) infants were given antifungals or other antibiotics.
• Prolonged exposure (5-7 days) was related with an increased risk of moderate to severe BPD or mortality. The use of broad-spectrum antibiotics (1-7 days) was also linked to an elevated risk of moderate to severe BPD and mortality.

Overall, this analysis of VPIs at low risk for EOS, extended or broad-spectrum antibiotic use was linked to an elevated chance of acquiring moderate to severe BPD or mortality. These findings indicate that VPIs who were exposed to extended or broad-spectrum antibiotics early in infancy should be monitored for the potential complications.

Source:

Shi, W., Chen, Z., Shi, L., Jiang, S., Zhou, J., Gu, X., Lei, X., Xiao, T., Zhu, Y., Qian, A., Zhou, W., Lee, S. K., Du, L., Yang, J., Ma, X., Hu, L., Chen, C., Cao, Y., … Chen, X. (2024). Early Antibiotic Exposure and Bronchopulmonary Dysplasia in Very Preterm Infants at Low Risk of Early-Onset Sepsis. In JAMA Network Open (Vol. 7, Issue 6, p. e2418831). American Medical Association (AMA). https://doi.org/10.1001/jamanetworkopen.2024.18831