Neonatal Antibiotic Exposure and the Risk of Childhood Obesity in South Bronx Pediatric Population

Abstract

Abstract BACKGROUND Currently, 1 in 3 children in the United States is diagnosed as overweight or obese. The intestinal microbiome is associated with the development of early-onset obesity and chronic inflammatory diseases. Alteration of the gut microbiome through antibiotic exposure has been implicated in weight gain in animal models. However, research on similar effects in humans remained inconclusive, and studies during the critical neonatal period are sparse. OBJECTIVE To assess the association between neonatal antibiotic exposure and the risk of childhood obesity and to evaluate the difference in effect based on the duration of antibiotic exposure. METHODS This retrospective cohort study entailed a chart review for neonates born between 2011 to 2015 and followed up until five years of age in a community hospital in South Bronx, New York. BMI percentile at five years of age and other characteristics were compared between the antibiotic-exposed and unexposed groups. Premature infants (less than 34 weeks) and those with congenital syndromes affecting growth were excluded from the study. A Chi-square test was conducted on categorical variables and a student's T-test for normally distributed continuous variables. Significant variables (p-value less than 0.05) in bivariate analysis were modeled in a stepwise multivariate logistic regression analysis to ascertain independent predictors of obesity at five years of age. RESULTS Of the 1447 subjects, 749 (52%) received ampicillin and gentamicin, and 333 (23%) were obese. Male-to-female distribution was similar. Neonates exposed to the antibiotics were more likely to be obese compared to unexposed (26% versus 20%, p-value of 0.01). Following adjustments for early feeding practices, childhood atopy, birth weight, maternal hypertension, diabetes, obesity, and ethnicity, this association persisted (aOR: 1.37, p-value 0.018). There is no significant difference in weight outcome among children who received antibiotics for less than or equal to 72 hours and greater than 72 hours (26.7% versus 23.2%, respectively with a p-value of 0.31). CONCLUSION Neonatal antibiotic exposure is independently associated with early childhood obesity, indicating that antibiotic exposure may play a significant role in the weight trajectory of these children. Hence, antibiotic stewardship in this period cannot be over-emphasized. Given the high incidence of childhood obesity among our cohort (23%) compared to the national average of 13.4% among children 2–5 years of age, augmenting current efforts at reducing traditional obesity risk factors with judicious antibiotic use will reduce the prevalence of childhood obesity and the attendant cardiovascular comorbidity.