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. 2020 Dec:227:128-134.e2.
doi: 10.1016/j.jpeds.2020.06.032. Epub 2020 Jun 14.

Early Use of Antibiotics Is Associated with a Lower Incidence of Necrotizing Enterocolitis in Preterm, Very Low Birth Weight Infants: The NEOMUNE-NeoNutriNet Cohort Study

Yanqi Li  1 , René Liang Shen  2 , Adejumoke I Ayede  3 , Janet Berrington  4 , Frank H Bloomfield  5 , Olubunmi O Busari  3 , Barbara E Cormack  6 , Nicholas D Embleton  4 , Johannes B van Goudoever  7 , Gorm Greisen  8 , Zhongqian He  9 , Yan Huang  10 , Xiaodong Li  9 , Hung-Chih Lin  11 , Jiaping Mei  12 , Paula P Meier  13 , Chuan Nie  14 , Aloka L Patel  13 , Per T Sangild  15 , Thomas Skeath  4 , Karen Simmer  16 , Signe Uhlenfeldt  2 , Marita de Waard  7 , Sufen Ye  12 , Xuqiang Ye  17 , Chunyi Zhang  18 , Yanna Zhu  19 , Ping Zhou  10
Affiliations

Early Use of Antibiotics Is Associated with a Lower Incidence of Necrotizing Enterocolitis in Preterm, Very Low Birth Weight Infants: The NEOMUNE-NeoNutriNet Cohort Study

Yanqi Li et al. J Pediatr. 2020 Dec.

Abstract

Objective: To determine whether commencement of antibiotics within 3 postnatal days in preterm, very low birth weight (VLBW; ≤1500 g) infants is associated with the development of necrotizing enterocolitis (NEC).

Study design: Preplanned statistical analyses were done to study the association between early antibiotic treatment and later NEC development, using the NEOMUNE-NeoNutriNet cohort of VLBW infants from 13 neonatal intensive care units (NICUs) in 5 continents (n = 2831). NEC incidence was compared between infants who received early antibiotics and those who did not, with statistical adjustments for NICU, gestational age, birth weight, sex, delivery mode, antenatal steroid use, Apgar score, and type and initiation of enteral nutrition.

Results: The incidence of NEC was 9.0% in the group of infants who did not receive early antibiotics (n = 269), compared with 3.9% in those who did receive early antibiotics (n = 2562). The incidence remained lower in the early antibiotic group after stepwise statistical adjustments for NICU (OR, 0.57; 95% CI, 0.35-0.94, P < .05) and other potential confounders (OR, 0.25; 95% CI, 0.12-0.47; P < .0001).

Conclusions: In this large international cohort of preterm VLBW infants, a small proportion of infants did not receive antibiotics just after birth, and these infants had a higher incidence of NEC. It is important to better understand the role of such variables as time, type, and duration of antibiotic treatment on NEC incidence, immune development, gut colonization, and antibiotic resistance in the NICU.

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Figures

Figure 1.
Figure 1.
Flowchart for inclusion of study participants. AB, antibiotics; CRF, case report form
Figure 2.
Figure 2.
Forest plot of unadjusted OR of NEC incidence between early-antibiotics and no-early-antibiotics for each NICU. AB, antibiotics; CI, confidence interval; NEC, necrotizing enterocolitis; NICU, neonatal intensive care unit; OR, odds ratio; Model A, NICU site as the random effect and no adjustment for other fixed-effects; model B, model A with adjustment for gestational age, birth weight, and sex as fixed-effects; model C, model B with additional adjustment for delivery mode, use of antenatal steroids, and Apgar score at 5 min; model D, model C with additional adjustment for initiation time of enteral nutrition and type of enteral nutrition in the first week of life
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References

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