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Neonatal care

Most preterm neonates receive antibiotics despite concerns over risk and benefits

Research published in JAMA Network Open has shown that antibiotic therapy begins in most preterm neonates within the first three days of life.

Preterm baby in incubator


Researchers found that 78.6% of very low-birthweight babies and 87.0% of extremely low-birthweight babies began antibiotic therapy in the first three days of life

Most preterm neonates receive early antibiotic therapy despite evidence that this can be unnecessary and sometimes harmful, the results of a US study show[1].

The research team used data from 297 hospitals across the United States between 2009–2015, looking at 40,364 very low-birthweight babies (VLBW), including 12,947 extremely low-birthweight infants (ELBW), who survived for at least one day.

They found that, overall, 78.6% of VLBW and 87.0% of ELBW began antibiotic therapy in the first three days of life. Exposure rates varied across centres and there was no significant trend in early prescribing rates detected over the seven-year study period.

Antibiotics are frequently prescribed to preterm neonates because they have an increased risk of sepsis. However, research has shown that in those without confirmed bacterial infection, the risks may outweigh the benefits.

“These findings suggest a continued need for neonatal antibiotic stewardship efforts designed to help clinicians identify premature infants at lowest risk of [early-onset sepsis] to avoid non-indicated, and perhaps harmful, antibiotic exposure,” the team concluded in JAMA Network Open (25 May 2018).

Citation: Clinical Pharmacist DOI: 10.1211/CP.2018.20205131

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