Yanqi Li1, René Liang Shen2, Adejumoke I Ayede3, Janet Berrington4, Frank H Bloomfield5, Olubunmi O Busari3, Barbara E Cormack6, Nicholas D Embleton4, Johannes B van Goudoever7, Gorm Greisen8, Zhongqian He9, Yan Huang10, Xiaodong Li9, Hung-Chih Lin11, Jiaping Mei12, Paula P Meier13, Chuan Nie14, Aloka L Patel13, Per T Sangild15, Thomas Skeath4, Karen Simmer16, Signe Uhlenfeldt2, Marita de Waard7, Sufen Ye12, Xuqiang Ye17, Chunyi Zhang18, Yanna Zhu19, Ping Zhou10. 1. Comparative Pediatrics and Nutrition, University of Copenhagen, Copenhagen, Denmark. 2. Department of Neonatology, Rigshospitalet, Copenhagen, Denmark. 3. Neonatology Unit, Department of Pediatrics, College of Medicine, University of Ibadan and University College Hospital, Ibadan, Nigeria. 4. Department of Neonatology, Newcastle Hospitals NHS Foundation Trust, Newcastle, United Kingdom. 5. Liggins Institute, University of Auckland and Newborn Service, National Women's Health, Auckland, New Zealand. 6. Paediatric Dietitians, Starship Child Health, Liggins Institute, University of Auckland, Auckland, New Zealand. 7. Department of Pediatrics, Amsterdam UMC, Vrije Universiteit, Emma Children's Hospital, Amsterdam, the Netherlands. 8. Department of Neonatology, Rigshospitalet, Copenhagen, Denmark. Electronic address: Gorm.Greisen@regionh.dk. 9. Department of Neonatology, Shenzhen Nanshan People's Hospital, Shenzhen, China. 10. Department of Neonatology, Shenzhen Bao'an Maternal and Child Health Hospital, Shenzhen, China. 11. Department of Neonatology, Children's Hospital of China Medical University, Taichung, Taiwan. 12. Affiliated Shenzhen Maternity & Child Healthcare Hospital, Southern Medical University, Shenzhen, China. 13. Department of Pediatrics, Section of Neonatology, Rush University Children's Hospital, Chicago, IL. 14. Department of Neonatology, Guangdong Provincial Women & Children's Hospital, Guangzhou, China. 15. Comparative Pediatrics and Nutrition, University of Copenhagen, Copenhagen, Denmark; Department of Pediatrics and Adolescent Medicine, Rigshospitalet, Copenhagen, Denmark; Hans Christian Andersen Children's Hospital, Odense, Denmark. 16. Centre for Neonatal Research and Education, University of Western Australia and King Edward Memorial Hospital, Perth, Australia. 17. Foshan Woman and Children's Hospital, Foshan, China. 18. Department of Neonatology, Guangdong Provincial Women & Children's Hospital, Guangzhou, China; Jinan University, Guangzhou, China. 19. School of Public Health, Sun Yat-sen University, Guangzhou, China.
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. Crown
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. Crown
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