Prolonged antibiotic therapy tied to necrotising enterocolitis risk in low birth weight infants

  • Raba AA & al.
  • Eur J Pediatr
  • 4 Apr 2019

  • curated by Sarfaroj Khan
  • UK Clinical Digest
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Takeaway

  • Prolonged exposure to antibiotic therapy is associated with increased risk for necrotising enterocolitis (NEC) among very low birth weight (VLBW; birth weight
  • Compared with other antibiotics, gentamicin and meropenem had a significant association with the incidence of NEC.

Why this matters

  • Findings suggest physicians should prescribe antibiotics that have optimal effects, and for the shortest possible duration in infants with suspected or proven sepsis to prevent the potential serious side effects of antibiotics, such as NEC.

Study design

  • This retrospective case-control study included 371 VLBW infants admitted to neonatal intensive care unit between 2012 and 2014.
  • Cases of NEC stage IIA or higher (n=22) according to Bell’s modified criteria, were matched with control infants (n=32).
  • Funding: None disclosed.

Key results

  • Prolonged exposure to the empirical antibiotic was significantly associated with an increased risk for NEC (cases: 5 [interquartile range [IQR, 3-6] days vs controls: 3 [IQR, 0-5] days; P =.05).
  • The infants with NEC were exposed to a significantly more frequent number of antibiotic courses and to more days on any antibiotic given before development of NEC (cases: 1 [IQR, 1-2] course vs controls: 1 course [IQR, 0.3-1] course; P =.03).
  • Significant differences between cases and controls were observed with respect to the duration of exposure, specifically to gentamicin (6 [IQR, 0-6] days vs 3 [IQR, 3-8] days; P=.03) and meropenem (0 [IQR, 0-4] days vs 0 [IQR, 0-0] days; P=.03).
  • Prolonged exposure to initial antibiotics for more than 5 days was associated with a 3.6-fold increase in the risk of a baby developing NEC (OR 3.6; 95% CI, 1.13–11.47)

Limitations

  • Retrospective design.
  • Small sample size.

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