At 25 tertiary neonatal intensive care units (NICUs) in China, preterm infants without infections had higher risks of bronchopulmonary dysplasia (BPD) and late antibiotic use (after 7 days of age) when they were treated earlier with antibiotics, a study shows. “Judicious early antibiotic use, especially avoiding prolonged duration and broad-spectrum antibiotics among noncritical infants, may improve neonatal outcomes and overall antibiotic use in NICUs,” the authors conclude.
A composite outcome of death or adverse morbidities produced these results in this cohort study: “Among 21,540 infants, 18,302 (85.0%) received early antibiotics. Early antibiotics was related to increased … BPD (adjusted odds ratio [aOR], 1.28; 95% confidence interval [CI], 1.05-1.56), late antibiotic use (aOR, 4.64; 95% CI, 4.19-5.14), and late antibiotic use rate (adjusted mean difference, 130 days/1000 patient-days; 95% CI, 112-147). Each additional day of early antibiotics was associated with increased BPD (aOR, 1.07; 95% CI, 1.04-1.10) and late antibiotic use (aOR, 1.41; 95% CI, 1.39-1.43). Broad-spectrum antibiotics showed larger effect size on neonatal outcomes than narrow-spectrum antibiotics. The correlation between early antibiotics and outcomes was significant among noncritical infants but disappeared for critical infants.”