Adverse consequences of neonatal antibiotic exposure

Abstract

Purpose of the review Antibiotics have saved lives and improved outcomes, but they also influence the evolving microbiome. This review 1) summarizes reports on neonatal infections and variation in antibiotic utilization, 2) discusses the emergence of resistant organisms, and 3) presents data from human neonates and animal models demonstrating impact of antibiotics on the microbiome, and how microbiome alterations impact health. The importance of antibiotic stewardship is also discussed. Recent findings Infections increase neonatal morbidity and mortality. Furthermore, the clinical presentation of infections can be subtle, prompting clinicians to empirically start antibiotics when infection is a possibility. Antibiotic-resistant infections are a growing problem. Cohort studies have identified extensive center variations in antibiotic usage and associations between antibiotic exposures and outcomes. Studies of antibiotic-induced microbiome alterations and downstream effects on the developing immune system have increased our understanding of the mechanisms underlying the associations between antibiotics and adverse outcomes. The emergence of resistant microorganisms and recent evidence linking antibiotic practice variations with health outcomes has led to initiation of antibiotic stewardship programs. Summary This review encourages practitioners to assess local antibiotic use with regard to local microbiology, and to adopt steps to reduce infections and use antibiotics wisely.

Antibiotic prescribing in neonatal sepsis: an Australian nationwide survey

“…In our study, only a small number of sepsis prescriptions (4%) were for microbiologically confirmed infections. While antibiotics may be life-saving, they are also associated with adverse effects, including impact on the neonate microbiome, 25 with potential long-term atopic and metabolic consequences of antibiotics in early life including asthma 26 and obesity. 27 A rational prescribing approach includes 'making a (differential) diagnosis, estimating prognosis, establishing the goals of therapy, selecting the most appropriate treatment and monitoring the effects of that treatment'.…”

Necrotizing enterocolitis

“…This seminal observation suggested a role for the microbiome in NEC pathogenesis with changes in intestinal microbiota composition now noted . Common interventions in the NICU such as antibiotic use and antacids lead to an increased incidence of NEC, presumably by altering the intestinal microbiome composition …”

“…43 Common interventions in the NICU such as antibiotic use and antacids lead to an increased incidence of NEC, presumably by altering the intestinal microbiome composition. 44,45…”

A Review of Antibiotic Used in Suspected Early-Onset Neonatal Sepsis From Malaysian Perspective: Which Ones to Choose and How Long to Give?

“…In Malaysia, neonatal deaths for the year 2000 were reported at 1 per 2000 deaths [2]. Infection remains a significant contributing factor for mortality and morbidity in view of their immature immune system especially in premature neonates [3,4].…”

“…The role of empiric antibiotic in suspected EOS is crucial to reduce the morbidity and mortality risks [21][22][23]. This is a biggest challenge to the physician since signs and symptoms of neonatal sepsis are nonspecific and empiric antibiotic often used in neonates who are not infected [4,7,24]. It is pertinent that the choice of empiric antibiotic in suspected EOS must have both Gram-positive and Gram-negative bacterial coverage.…”