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Pediatrics. 2019 Mar;143(3). pii: e20182286. doi: 10.1542/peds.2018-2286.

Duration of Initial Empirical Antibiotic Therapy and Outcomes in Very Low Birth Weight Infants.

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Department of Pediatrics, The University of British Columbia, Vancouver, British Columbia, Canada.
Neonatal Program, British Columbia Women's Hospital and Health Centre.
Department of Pediatrics, Surrey Memorial Hospital, Surrey, British Columbia, Canada.
Department of Pediatrics, Saint John Regional Hospital, Saint John, New Brunswick, Canada.
Department of Pediatrics, Royal Columbian Hospital, Vancouver, British Columbia, Canada.
Department of Newborn and Developmental Paediatrics, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.
The Centre Hospitalier Universitaire Sainte-Justine, Montréal, Quebec, Canada.
Maternal-Infant Care Research Centre, Mount Sinai Hospital, Toronto, Ontario, Canada; and.
Department of Pediatrics, Sinai Health System and University of Toronto, Toronto, Ontario, Canada.


: media-1vid110.1542/5984244681001PEDS-VA_2018-2286Video Abstract BACKGROUND: Overuse of antibiotics can facilitate antibiotic resistance and is associated with adverse neonatal outcomes. We studied the association between duration of antibiotic therapy and short-term outcomes of very low birth weight (VLBW) (<1500 g) infants without culture-proven sepsis.


We included VLBW infants admitted to NICUs in the Canadian Neonatal Network between 2010-2016 who were exposed to antibiotics but did not have culture-proven sepsis in the first week. Antibiotic exposure was calculated as the number of days an infant received antibiotics in the first week of life. Composite primary outcome was defined as mortality or any major morbidity (severe neurologic injury, retinopathy of prematurity, necrotizing enterocolitis, chronic lung disease, or hospital-acquired infection).


Of the 14 207 included infants, 21% (n = 2950), 38% (n = 5401), and 41% (n = 5856) received 0, 1 to 3, and 4 to 7 days of antibiotics, respectively. Antibiotic exposure for 4 to 7 days was associated with higher odds of the composite outcome (adjusted odds ratio 1.24; 95% confidence interval [CI] 1.09-1.41). Each additional day of antibiotic use was associated with 4.7% (95% CI 2.6%-6.8%) increased odds of composite outcome and 7.3% (95% CI 3.3%-11.4%) increased odds in VLBW infants at low risk of early-onset sepsis (born via cesarean delivery, without labor and without chorioamnionitis).


Prolonged empirical antibiotic exposure within the first week after birth in VLBW infants is associated with increased odds of the composite outcome. This practice is a potential target for antimicrobial stewardship.


Conflict of interest statement

POTENTIAL CONFLICT OF INTEREST: The authors have indicated they have no potential conflicts of interest to disclose.

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