545 - Association of Neonatal Antibiotic Exposure with Long-term Growth Trajectory Faltering in Preterm-birth Children

Poster Number: 545
Publication Number: 545.3204

Background: Studies that mostly focused on term-birth infants have provided evidence that early-life antibiotic exposure increases the risk of childhood obesity. However, preterm neonates are often exposed to a variety duration of empirical antibiotics even without culture-confirmed infections or severe invasive bacterial infection during admission, and the impact of neonatal prolonged antibiotic exposure on the longitudinal growth remains unknown.

Objective: To evaluate whether neonatal antibiotic exposure is relevant with longitudinal growth problems in preterm-birth children.

Design/Methods: This prospective study enrolled 481 infants who were born < 32 weeks’ gestation, discharged, and longitudinally followed from corrected age (CA) 6 to 60 months. After excluding 153 infants with blood culture-confirmed bacteremia, necrotizing enterocolitis, severe cerebral palsy, intestinal-stomy, and congenital anomaly, 328 infants were included for analysis. Covariates included perinatal demographics, neonatal morbidities, extra-uterine growth restriction, and antibiotic exposure accumulated by term equivalent age. The primary outcome was the anthropometric trajectories in z-score of bodyweight (zBW), body-height (zBH) and body mass index (zBMI) from corrected age 6 to 60 months.

Results: Antibiotic exposure duration significantly negative assocated with zBW and zBH at CA 6, 12 and 60 months, and zBMI at CA 60 months. Multivariate generalized estimating equation analyses showed antibiotic exposure duration had significantly faltering z-score increment from CA 6 to 60 months in zBW and zBH [adjusted mean (95% CI); ΔzBW: -0.021 (-0.041– -0.001), p=0.042; ΔzBH: -0.019 (-0.035– -0.002), p =0.027] after adjustment. Children with neonatal antibiotic exposure duration >15 days was significantly lower in the mean anthropometric zBW, zBH and zBMI at CA 6, 12, 24 and 60 months compared with children with neonatal antibiotic exposure ≤15 days (all p< 0.01).

Conclusion(s): Growth increments were negatively associated with antibiotic exposure duration in preterm neonates implicating antibiotic stewardship and growth follow-up for preterm neonates are thus warranted.