Early antibiotic use in VLBW preemies ups risk of death, NEC, late-onset sepsis
Antibiotic therapy in preterm, very low birth weight (VLBW) infants within the first 14 postnatal days increases the risk of subsequent late-onset sepsis, necrotizing enterocolitis (NEC) or death, a recent study has shown.
Researchers retrospectively assessed 374 VLBW preterm infants (53 percent male; median birth weight, 1,130 grams) admitted to the neonatal intensive care unit. Mean antibiotic exposure was 8.8±6 days of therapy, with 39 percent (n=145) receiving at least 5 calendar days of antibiotic therapy.
Seventy infants (19 percent) developed the composite outcome of late-onset sepsis (14 percent; n=52), NEC (6 percent; n=24) or death (3 percent; n=11). Median age at composite development was 29 days (sepsis: 29 days; NEC: 35 days; death: 31 days).
Multivariable logistic regression models showed that each day-of-therapy of antibiotic medication during the first 2 weeks of life was associated with an increased subsequent risk of the composite outcome (odds ratio [OR], 1.24; 95 percent CI, 1.17–1.31).
Similar risk patterns emerged when infants were stratified by gestational age (≤296/7 weeks: OR, 1.20; 1.12–1.29; ≥300/7 weeks: OR, 1.30; 1.17–1.43).
When length of therapy was instead used, researchers still found an increased risk of the composite outcome per additional day of exposure (OR, 1.47; 1.32–1.64). Receiver operating characteristic analysis showed that both measures of exposure provided similar and good areas under the curve.
The findings indicate that use of antibiotics in infants without proven infection should be carefully considered, as the associated risks can be significant, said researchers.