253 - Effect of any antibiotic therapy on Bronchopulmonary Dysplasia (BPD) in the absence of proven early onset neonatal sepsis in very low birth weight infants (VLBWI)

Poster Number: 253
Publication Number: 253.3006

Background: The use of antibiotics for more than 3 days just after birth in VLBWI with negative cultures has shown worrying results.

Objective: To evaluate the mortality and the development rate of bronchopulmonary dysplasia, separately and in a composite outcome, in all neonates born alive with a gestational age (GA) < 33 weeks who used any duration of empiric antibiotics compared to those who did not.

Design/Methods: Newborns with GA < 33 weeks and clinically presumed early onset sepsis born from 2014 to 2021, were retrospectively analyzed. Patients were allocated into two groups, one received empirical antibiotic therapy regardless of the duration of antibiotic therapy and the other did not receive any antibiotics. Preterms with confirmed infections or malformations were excluded. Institutional Ethical Committee approved. The main outcome of the study was to analyze the development of BPD (oxygen therapy or ventilatory support at 36th gestational age) between the groups. Secondary outcomes were mortality and a combined outcome of either development of BPD or death during hospitalization. The analysis included a univariate and subsequently a multivariate logistic regression.

Results: A total of 454 preterm infants (279 received antibiotics, 175 did not) were included with a mean body weight of 1078± 276 g and GA of 29.2± 2 weeks. In univariate analyses, patients who received antibiotics developed more BPD (35.5% vs 10.3%, p < 0.001) and had more deaths (21.5% vs 8.6%, p < 0.001) than those who did not use them. After controlling for birth weight, there was no difference in mortality, but infants who received antibiotics had developed more BPD (OR 2.48, 1.59-5.23), p < 0.001 and had a worst composite outcome (BPD and death) (OR 2.25, 1.26-4.05), p < 0,006.

Conclusion(s): The independent use of antibiotics in patients with presumed early onset sepsis, but with a subsequent negative culture, regardless the duration of use, was associated with increased incidence BPD and a combined outcome of BPD and death during hospitalization.