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. 2026 Jan:288:114839.
doi: 10.1016/j.jpeds.2025.114839. Epub 2025 Sep 26.

Antibiotic Prophylaxis for Gastrointestinal Surgery among Neonates and Very Young Infants: National Patterns, Outcomes, and Opportunities for Precision Stewardship

Humza Thobani  1 , Roshni Mathew  2 , Anam N Ehsan  1 , Anoosha Moturu  3 , Muhammad Osama Khan  4 , Laura Bio  5 , Meera Sankar  6 , Timothy F Tirrell  1 , Adil A Shah  7 , Chad M Thorson  8 , Steven L Raymond  9 , Saleem Islam  4 , Karl G Sylvester  1 , Faraz A Khan  10
Affiliations

Antibiotic Prophylaxis for Gastrointestinal Surgery among Neonates and Very Young Infants: National Patterns, Outcomes, and Opportunities for Precision Stewardship

Humza Thobani et al. J Pediatr. 2026 Jan.

Abstract

Objective: To evaluate nationwide adherence to surgical antibiotic prophylaxis (SAP) guidelines and its association with outcomes following gastrointestinal surgeries among neonates and infants.

Study design: We queried the National Surgical Quality Improvement Program-Pediatric for all patients age <90 days undergoing select thoracoabdominal surgical procedures between 2021 and 2023. Procedures were further subcategorized by anatomic site. SAP regimens were classified as being "adherent," "undercoverage," or "overcoverage" per established guidelines and expert consensus. The primary outcome was surgical site infection (SSI). Associations between SAP classification and SSI rates for each procedure subcategory were analyzed, with further subset analyses to delineate the effects of common SAP regimens on postoperative outcomes.

Results: A total of 11 062 cases met criteria, with an overall SAP adherence of 87.2%. Rates of overcoverage (2.8%-55.5%) and undercoverage (2.8%-28.3%) varied widely by procedure type. SAP undercoverage did not increase the odds of SSI for most procedures analyzed, with the exception of patients undergoing colorectal procedures, in whom cefazolin monotherapy (undercoverage) was associated with higher odds of SSI (OR = 2.17, 95% CI = 1.08-4.18). Broadening SAP coverage (overcoverage) and prolonging SAP duration were not associated with reduced SSI rates for any subcategory of procedure.

Conclusions: Adherence to empiric SAP guidelines was poor among neonates and very young infants undergoing surgical intervention. There appears to be limited benefit to broadening SAP coverage for surgery in this patient population. These findings underscore the need for increased adherence to recommendations driven by neonatal-specific data, aiming to balance optimized postoperative outcomes with antimicrobial stewardship goals.

Keywords: antibiotic prophylaxis; antimicrobial stewardship; infant; neonate; surgical prophylaxis.

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Conflict of interest statement

Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. This research did not receive any specific financial assistance from funding agencies in the public, commercial, or not-for-profit sectors.

MeSH terms

Substances