ArticleEuropean journal of pediatrics2022
Association between duration of early empiric antibiotics and necrotizing enterocolitis and late-onset sepsis in preterm infants: a multicenter cohort study.
Article in European journal of pediatrics, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 32 papers, 1 of them a synthesis that pooled it.
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32 citing papers in PubMed, 1 synthesis or guideline pooled it, 35 citations in OpenAlex.
- Management of neonates at risk of early onset sepsis: a probability-based approach and recent literature appraisal : Update of the Swiss national guideline of the Swiss Society of Neonatology and the Pediatric Infectious Disease Group Switzerland.European journal of pediatrics · 2024Guideline
- Effect of early antibiotic exposure on necrotizing enterocolitis and growth in extremely preterm infants.Pediatric research · 2025Trial
- The Goldilocks zone of optimal antimicrobial stewardship in preterm infants.Pediatric research · 2026Article
- Compact Gut Microbial Dysbiosis Signature Associated with Necrotizing Enterocolitis and Altered Early Microbiota Development.Pathogens (Basel, Switzerland) · 2026Article
- Association of early probiotic exposure with age at NEC onset in preterm Infants: A retrospective multicenter study.Scientific reports · 2026Article
- Does the duration of empiric antibiotic treatment influence NEC incidence and severity relative to placental pathology?Journal of neonatal-perinatal medicine · 2026Review
- Association of Placental Pathology and Antibiotic Exposure after Birth with the Severity of Necrotizing Enterocolitis in Preterm Infants: A Case-Control Study.American journal of perinatology · 2026Article
- Article
- Association between initial empirical antibiotic therapy and necrotizing enterocolitis in very preterm infants at different risk for early-onset sepsis: a multicenter cohort study.BMC pregnancy and childbirth · 2026Observational
- Antibiotic exposure in culture-negative preterm infants: a 10-year single-centre study.Pediatric research · 2026Article
- Early antibiotic exposure and necrotizing enterocolitis among preterm infants < 34 weeks' gestation.Pediatric research · 2025Article
- Early antibiotic exposure and the risk of necrotizing enterocolitis in preterm neonates: insights from a large multicenter cohort in China.Pediatric research · 2025Article
- Review
- Is Shorter (3-4 Days) Antibiotic Therapy Adequate Compared to Standard (5-7 Days) Duration in Neonates with Suspected (Culture Negative) Sepsis? Yes.Indian pediatrics · 2025Article
- The double-edged sword of early antibiotic exposure in extremely preterm infants: implications for necrotizing enterocolitis and growth faltering.Pediatric research · 2025Article
- The association of early antibiotic exposure with subsequent development of late-onset sepsis in preterm infants: a systematic review and meta-analysis studies.International journal of emergency medicine · 2025Review
- Understanding variation in management of early-onset neonatal sepsis in India: a vignette-based survey.BMJ paediatrics open · 2025Article
- A study protocol for neonatal sepsis and gut microbiomics among preterm infants admitted at Muhimbili National Hospital, Tanzania.PloS one · 2025Article
- Prevention Strategies and Management of Necrotizing Enterocolitis.Current treatment options in pediatrics · 2024Article
- Shifting the antibiotic rhetoric in children from 'just in case' to 'disclose the risk': Has the time come?Journal of the Association of Medical Microbiology and Infectious Disease Canada = Journal officiel de l'Association pour la microbiologie medicale et l'infectiologie Canada · 2024Article
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Authors and funding
18 authors at 11 institutions in 2 countries.
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Abstract
The threshold to initiate empiric antibiotics for suspicion of early-onset sepsis (EOS) is low in preterm infants. Antibiotics' effects on short-term outcomes have recently been debated. We aimed at exploring the extent of early empiric antibiotic exposure (EEAE) in preterm infants and the association between the duration of EEAE with necrotizing enterocolitis (NEC) and late-onset sepsis (LOS) within different EEAE groups. EEAE practice for suspicion of EOS was evaluated in all included infants (gestational age < 30 weeks) born in 9 centers in the Netherlands and Belgium between Oct. 2014 and Jan. 2019. EEAE association with NEC and LOS development was analyzed by multivariate regression. After excluding 56 EOS cases, 1259 infants were included. A total of 1122 infants (89.1%) were exposed to empirical antibiotics for the suspicion of EOS of whom 802 (63.7%) had short (≤ 72 h) and 320 (25.4%) prolonged EEAE (> 72 h). Infants with EEAE ≤ 72 h had a lower incidence of NEC compared to both infants without EEAE (adjusted odds ratio (aOR) 0.39; 95% confidence interval (CI) [0.19-0.80]; p = 0.01) and with prolonged EEAE (> 72 h) (aOR [95%CI]: 0.58 [0.35-0.96]; p = 0.03). With every additional day of EEAE, LOS incidence decreased (aOR [95%CI]: 0.90 [0.85-0.97]; p = 0.003).
conclusionAlmost 90% of preterm infants who have negative blood culture results in the first 72 h of life are exposed to EEAE under suspicion of EOS. One-fourth has prolonged EEAE. Duration of EEAE was differently associated with NEC and LOS incidence. The effects of antibiotics, and potentially induced microbial dysbiosis related to development of NEC and LOS, should further be explored. WHAT IS KNOWN: • Preterm infants often receive antibiotics empirically directly after birth for suspicion of early-onset sepsis. • The effects of the duration of early empirical antibiotic exposure on the risk for necrotizing enterocolitis and late-onset sepsis are debated. WHAT IS NEW: • Almost 90% of preterm infants with a gestational age below 30 weeks are exposed to antibiotics empirically after birth despite negative culture results. In a quarter of these culture-negative infants, empirical antibiotics are prolonged. • A short course of empirical antibiotics (≤72h) is associated with decreased odds for necrotizing enterocolitis compared to both prolonged (>72h) or no empirical antibiotics after birth. Furthermore, every additional day of empirical antibiotic exposure is associated with decreased risk for late-onset sepsis in the first month of life.
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