Early Antibiotic Exposure and Bronchopulmonary Dysplasia in Very Preterm Infants at Low Risk of Early-Onset Sepsis
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Published:2024-06-27
Issue:6
Volume:7
Page:e2418831
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ISSN:2574-3805
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Container-title:JAMA Network Open
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language:en
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Short-container-title:JAMA Netw Open
Author:
Shi Wei12, Chen Zheng12, Shi Liping12, Jiang Siyuan34, Zhou Jianguo34, Gu Xinyue4, Lei Xiaoping5, Xiao Tiantian6, Zhu Yanping7, Qian Aimin8, Zhou Wenhao34, Lee Shoo K.9, Du Lizhong12, Yang Jie4, Ma Xiaolu12, Hu Liyuan34, , Chen Chao10, Cao Yun10, Chen Xiuyong10, Zhang Huyan10, Tian Xiuying10, Shi Jingyun10, Li Zhankui10, Yang Chuanzhong10, Liu Ling10, Yang Zuming10, Fu Jianhua10, Ji Yong10, Chen Dongmei10, Yang Changyi10, Chen Rui10, Peng Xiaoming10, Shan Ruobing10, Han Shuping10, Wu Hui10, Wang Lili10, Wei Qiufen10, Li Mingxia10, Dai Yiheng10, Jiang Hong10, Kang Wenqing10, Gong Xiaohui10, Zhong Xiaoyun10, Shi Yuan10, Jiang Shanyu10, Sun Bing10, Li Long10, Lin Zhenlang10, Liu Jiangqin10, Pan Jiahua10, Xia Hongping10, Li Xiaoying10, Xu Falin10, Qiu Yinping10, Ma Li10, Yang Ling10, He Xiaori10, Li Yanhong10, Zhuang Deyi10, Zhang Qin10, Dong Wenbin10, Sun Jianhua10, Liang Kun10, Wang Huaiyan10, Feng Jinxing10, Chen Liping10, Lin Xinzhu10, Jiang Chunming10, Nie Chuan10, Zeng Linkong10, Hei Mingyan10, Zhu Hongdan10, Mi Hongying10, Yin Zhaoqing10, Song Hongxia10, Wang Hongyun10, Li Dong10, Gao Yan10, Wang Yajuan10, Dai Liying10, Zhang Liyan10, Li Yangfang10, Zhang Qianshen10, Ding Guofang10, Wang Jimei10, Chen Xiaoxia10, Wang Zhen10, Tang Zheng10, Zhang Xiaomei10, Zhang Xiaolan10, Wu Fang10, Chen Yanxiang10, Wu Ying10, Ting Joseph10
Affiliation:
1. Neonatal Intensive Care Unit, Children’s Hospital, Zhejiang University School of Medicine, Hangzhou, China 2. National Clinical Research Center for Child Health, Hangzhou, China 3. Department of Neonatology, Children’s Hospital of Fudan University, Shanghai, China 4. National Health Commission Key Laboratory of Neonatal Diseases, Fudan University, Children’s Hospital of Fudan University, Shanghai, China 5. Division of Neonatology, Department of Pediatrics, The Affiliated Hospital of Southwest Medical University, Luzhou, China 6. Department of Neonatology, Chengdu Women’s and Children’s Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China 7. Department of Neonatology, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China 8. Department of Neonatology, Children’s Hospital of Nanjing Medical University, Nanjing, China 9. Maternal-Infant Care Research Center and Department of Pediatrics, Mount Sinai Hospital, Toronto, Ontario, Canada 10. for the Chinese Neonatal Network
Abstract
ImportanceThe overutilization of antibiotics in very preterm infants (VPIs) at low risk of early-onset sepsis (EOS) is associated with increased mortality and morbidities. Nevertheless, the association of early antibiotic exposure with bronchopulmonary dysplasia (BPD) remains equivocal.ObjectiveTo evaluate the association of varying durations and types of early antibiotic exposure with the incidence of BPD in VPIs at low risk of EOS.Design, Setting, and ParticipantsThis national multicenter cohort study utilized data from the Chinese Neonatal Network (CHNN) which prospectively collected data from January 1, 2019, to December 31, 2021. VPIs less than 32 weeks’ gestational age or with birth weight less than 1500 g at low risk of EOS, defined as those born via cesarean delivery, without labor or rupture of membranes, and no clinical evidence of chorioamnionitis, were included. Data analysis was conducted from October 2022 to December 2023.ExposureEarly antibiotic exposure was defined as the total number of calendar days antibiotics were administered within the first week of life, which were further categorized as no exposure, 1 to 4 days of exposure, and 5 to 7 days of exposure.Main Outcomes and MeasuresThe primary outcome was the composite of moderate to severe BPD or mortality at 36 weeks’ post menstrual age (PMA). Logistic regression was employed to assess factors associated with BPD or mortality using 2 different models.ResultsOf the 27 176 VPIs included in the CHNN during the study period (14 874 male [54.7%] and 12 302 female [45.3%]), 6510 (23.9%; 3373 male [51.8%] and 3137 female [48.2.%]) were categorized as low risk for EOS. Among them, 1324 (20.3%) had no antibiotic exposure, 1134 (17.4%) received 1 to 4 days of antibiotics treatment, and 4052 (62.2%) received 5 to 7 days of antibiotics treatment. Of the 5186 VPIs who received antibiotics, 4098 (79.0%) received broad-spectrum antibiotics, 888 (17.1%) received narrow-spectrum antibiotics, and 200 (3.9%) received antifungals or other antibiotics. Prolonged exposure (5-7 days) was associated with increased likelihood of moderate to severe BPD or death (adjusted odds ratio [aOR], 1.23; 95% CI, 1.01-1.50). The use of broad-spectrum antibiotics (1-7 days) was also associated with a higher risk of moderate to severe BPD or death (aOR, 1.27; 95% CI, 1.04-1.55).Conclusions and RelevanceIn this cohort study of VPIs at low risk for EOS, exposure to prolonged or broad-spectrum antibiotics was associated with increased risk of developing moderate to severe BPD or mortality. These findings suggest that VPIs exposed to prolonged or broad-spectrum antibiotics early in life should be monitored for adverse outcomes.
Publisher
American Medical Association (AMA)
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