master candidate The First Hospital of Jilin University Changchun, Jilin, China (People's Republic)
Background: Early antibiotic exposure has been associated with an increased risk of adverse outcomes in very-low-birth-weight (VLBW) infants; however, this association remains controversial in the field of necrotizing enterocolitis (NEC). Objective: To evaluate the association between the duration of initial empirical antibiotic therapy (IEAT) and NEC in VLBW infants at different early onset sepsis (EOS) risk. Design/Methods: Design: A cohort study of infants admitted from January 1, 2019, to December 31, 2021, to neonatal intensive care units (NICUs) contributing data to the Chinese Neonatal Network (CHNN) was performed. Setting: CHNN was comprised of 78 NICUs from 29 provinces throughout China. Participants: We enrolled VLBW infants, and the infants were assessed according to different EOS risk: (1) all VLBW infants, (2) VLBW infants without culture-proven EOS, and (3) VLBW infants with a low risk of EOS. Exposure: Early antibiotic treatment was initiated within three days after birth. Main Outcomes and Measures: The primary outcome was the incidence of NEC, and multivariate logistic regression analysis was used to analyse the association between NEC incidence and the duration of IEAT. The secondary outcome was the time to NEC onset, and Kaplan–Meier survival curves were constructed to assess the temporal association between IEAT and the onset of NEC. Results: In the entire cohort of VLBW infants (n=19516) and the VLBW infants without culture-proven EOS (n=19257), IEAT was associated with a delayed onset of NEC, with an adjusted hazard ratio of 1.25 (95% CI 1.01, 1.54; P＜0.05), but no increased risk of NEC incidence. Moreover, an IEAT duration of 1–5 days was linked to a decreased adjusted risk ratio (aRR) for NEC compared to that in VLBW infants with no antibiotic exposure (aRR 0.65, 95% confidence interval [CI] 0.45- 0.93; aRR 0.64 [95% CI 0.45, 0.93]. In VLBW infants with a low risk of EOS (n=8108), no significant association was observed between IEAT and NEC.
Conclusion(s): The short-term administration of IEAT within the initial five days of birth in VLBW infants is associated with decreased risk of NEC; moreover, IEAT may delay the onset of NEC in VLBW infants.
