Antibiotic Use in Neonatal Intensive Care

Soll, Roger F.

doi:10.1542/peds.2015-0707

Cited by 22 publications

(17 citation statements)

References 15 publications

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“…It had been considered good practice to screen babies who present with early respiratory distress for infection; however, it is now known that routine antibiotic prophylaxis has the potential to do more harm than good [141,142,143]. Guidelines usually offer advice on when to screen for sepsis based on additional risk factors such as maternal chorio-amnionitis or early signs of septicaemia in the hope that antibiotics are only prescribed for those at greatest risk [144].…”

Section: Monitoring and Supportive Carementioning

confidence: 99%

European Consensus Guidelines on the Management of Respiratory Distress Syndrome - 2016 Update

et al. 2016

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Advances in the management of respiratory distress syndrome (RDS) ensure that clinicians must continue to revise current practice. We report the third update of the European Guidelines for the Management of RDS by a European panel of expert neonatologists including input from an expert perinatal obstetrician based on available literature up to the beginning of 2016. Optimizing the outcome for babies with RDS includes consideration of when to use antenatal steroids, and good obstetric practice includes methods of predicting the risk of preterm delivery and also consideration of whether transfer to a perinatal centre is necessary and safe. Methods for optimal delivery room management have become more evidence based, and protocols for lung protection, including initiation of continuous positive airway pressure and titration of oxygen, should be implemented from soon after birth. Surfactant replacement therapy is a crucial part of the management of RDS, and newer protocols for surfactant administration are aimed at avoiding exposure to mechanical ventilation, and there is more evidence of differences among various surfactants in clinical use. Newer methods of maintaining babies on non-invasive respiratory support have been developed and offer potential for greater comfort and less chronic lung disease. As technology for delivering mechanical ventilation improves, the risk of causing lung injury should decrease although minimizing the time spent on mechanical ventilation using caffeine and if necessary postnatal steroids are also important considerations. Protocols for optimizing the general care of infants with RDS are also essential with good temperature control, careful fluid and nutritional management, maintenance of perfusion and judicious use of antibiotics all being important determinants of best outcome.

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Section: Monitoring and Supportive Carementioning

confidence: 99%

European Consensus Guidelines on the Management of Respiratory Distress Syndrome - 2016 Update

et al. 2016

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“…Roger Soll responded to the California NICUs report on variations in antibiotic practice by identifying increases in antibiotic resistant microorganisms as a major threat and direct result of our overuse of antibiotics. [41] Dr. Using data from the World Health Organization (WHO), he found the proportion of Escherichia coli , Klebsiella pneumoniae and Staphylococcus aureus resistant to commonly used antibacterial drugs exceeded 50% in many settings.…”

Section: Antibiotic Resistance: Emerging Problem For Neonatal Infectionsmentioning

confidence: 99%

Adverse consequences of neonatal antibiotic exposure

Cotten

2016

Current Opinion in Pediatrics

124

116

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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.

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“…По мнению других авторов [34,36], в предопера-ционном периоде лучшими характеристиками пользу-ется быстрая внутривенная инфузия, обеспечивающая необходимые концентрации препарата в крови и тка-нях в короткие сроки. Однако препараты, для которых быстрое введение сопряжено с опасностью развития общих и/или местных побочных реакций, вводят внутри-венно капельно.…”

Section: обоснованиеunclassified

“…F. Soll и W. Н. Edwards предлагают сократить не-нуж ное использование антибиотиков за счет улучше-ния диагностических и клинических подходов [36]. Так, использование новых методов идентификации генов бактерий помогут увеличить использование стандарт-ных посевов крови, особенно при исключении систем-ной инфекции [36]. Более сложные подходы по выяв-лению детей с риском раннего развития сепсиса могут привести к снижению эмпирического антибактериаль-ного лечения [17].…”

Section: обоснованиеunclassified

“…Более сложные подходы по выяв-лению детей с риском раннего развития сепсиса могут привести к снижению эмпирического антибактериаль-ного лечения [17]. Применение профилактических анти-микробных препаратов (например, флуконазола) для профилактики кандидоза должно быть также тщательно продумано [36].…”

Section: обоснованиеunclassified

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