KIDS
May 31, 2018

Preemies' Antibiotic Overload?

Infections are a serious risk for premature infants, but too many are given antibiotics without clear evidence of a problem.

Though babies born prematurely are at higher risk for infection and sepsis, too many preemies are being given antibiotics during the first few days of life, even when they do not need them, a study has found. And this can create its own set of problems.

Very-low- (1500 grams, about 4 pounds) and extremely-low-birth-weight infants (1000 grams, about 2 pounds) are at risk for infection because their bodies' systems are still fragile and unstable, so the antibiotics are given to protect them. Necrotizing enterocolitis is one risk. Another is early-onset sepsis; but this can be difficult to determine, as many hospitals' neonatal intensive care units administer antibiotics without first confirming that an infection exists.

Too many preemies are being given antibiotics during the first few days of life, even when they do not need them.

But early antibiotic exposure also carries risks. “…[P]rolonged antibiotic exposure in the absence of proven infection is also associated with significant morbidity and mortality,” writes Matthew Bizzarro, MD, a member of the perinatal division of the Department of Pediatrics at Yale University School of Medicine, in a Commentary on the study.

Researchers at Children's Hospital of Philadelphia looked at the records of over 40,000 low-birth-weight newborns and nearly 13,000 extremely low-birth-weight infants in previous studies. They found that 78 percent of low-birth-weight infants and 87 percent of extremely-low-birth-weight infants were given antibiotics over the six years covered by the study and that this rate did not change, even though rates of antibiotic use had dropped overall during that time.

There are good reasons to give premature infants antibiotics, especially when they are exposed to infection in the womb or suffer ruptures in delicate membranes that leave them vulnerable to infection, but as the Commentary points out, “It… seems apparent that a modified approach to risk assessment and early antibiotic prescription in premature infants is needed, but how best to proceed remains a challenge.”

The authors hope the analysis will provide the information needed to spur the development of guidelines for neonatal units around the country, to spare more preemies who do not have an immediate risk for infection unnecessary antibiotic exposure and the potential for antibiotic resistance.

The study appears in JAMA Network Open.

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