Repeated Early Antibiotic Use Linked to Reduced Lung Function in Preterm Children:JAMA
A recent study published in JAMA Network Open has revealed that repeated antibiotic exposure before and after birth in preterm infants is linked to reduced lung function by early school age. German researchers conducted the study, highlighting potential long-term respiratory effects of early antibiotic use. The study was conducted by Ingmar F. and colleagues.
Use of antibiotics in neonates, especially preterm-born neonates, is prevalent as they are highly susceptible to infections. Earlier animal research provided clues towards a potential link between initial antibiotic exposure and obstructive airway disease, but evidence for premature neonates did not exist. The aim of the current study was to bridge that gap by examining the effect of different perinatal antibiotic exposures on long-term respiratory outcomes among VLBW children born preterm.
This multicenter cohort study based on the population of 3,820 VLBW children born preterm (22-36 weeks of gestation, birth weight <1500 g) enrolled between January 2009 and March 2017 in 58 GNN centers included only those born through cesarean delivery in the final analysis. Perinatal exposure to antibiotics was classified based on an antibiotic risk score (ARS):
ARS I: Maternal surgical antimicrobial prophylaxis (SAP) alone.
ARS II: SAP and neonatal postnatal antibiotics.
ARS III: SAP, antenatal maternal treatment, and postnatal antibiotics.
Main outcomes were the FEV1 z score between 5 and 7 years. Secondary outcomes were FVC z score and childhood asthma attacks. Regression models were employed to examine the associations between respiratory outcomes and antibiotic exposure levels.
Key Findings
A total of 3,109 children born preterm were included in the final analysis, 292 (9.4%) in ARS I, 1,329 (42.7%) in ARS II, and 1,488 (47.9%) in ARS III.
Increased levels of ARS were related to decreased FEV1 z scores (ARS II vs I: β, −0.31; ARS III vs II: β, −0.27).
Increased levels of ARS were related to decreased FVC z scores (ARS III vs II: β, −0.23).
Children in the ARS III group had a 91% elevated risk of early childhood asthma (odds ratio, 1.91).
The study authors concluded that repeated perinatal exposures to antibiotics were linked with reduced lung function and a heightened risk of asthma in preterm children at school age. Recognition and reduction of high-risk exposures can potentially improve long-term respiratory outcomes in this susceptible population.
Reference:
Fortmann I, Welp A, Hoffmann N, et al. Perinatal Antibiotic Exposure and Respiratory Outcomes in Children Born Preterm. JAMA Netw Open. 2025;8(5):e259647. doi:10.1001/jamanetworkopen.2025.9647
