Broad-spectrum Antibiotic Plus Metronidazole May Not Prevent the Deterioration of Necrotizing Enterocolitis From Stage II to III in Full-term and Near-term Infants

Abstract

Necrotizing enterocolitis (NEC) is the most common and frequently dangerous neonatal gastrointestinal disease. Studies have shown broad-spectrum antibiotics plus anaerobic antimicrobial therapy did not prevent the deterioration of NEC among very low birth preterm infants. However, few studies about this therapy which focused on full-term and near-term infant with NEC has been reported. The aim of this study was to evaluate the effect of broad-spectrum antibiotic plus metronidazole in preventing the deterioration of NEC from stage II to III in full-term and near-term infants.A retrospective cohort study based on the propensity score (PS) 1:1 matching was performed among the full-term and near-term infants with NEC (Bell stage ≥II). All infants who received broad-spectrum antibiotics were divided into 2 groups: group with metronidazole treatment (metronidazole was used ≥4 days continuously, 15 mg/kg/day) and group without metronidazole treatment. The depraved rates of stage II NEC between the 2 groups were compared. Meanwhile, the risk factors associated with the deterioration of stage II NEC were analyzed by case-control study in the PS-matched cases.A total of 229 infants met the inclusion criteria. Before PS-matching, we found the deterioration of NEC rate in the group with metronidazole treatment was higher than that in the group without metronidazole treatment (18.1% [28/155] vs 8.1% [6/74]; P = 0.048). After PS-matching, 73 pairs were matched, and the depraved rate of NEC in the group with metronidazole treatment was not lower than that in the group without metronidazole treatment (15.1% vs 8.2%; P = 0.2). Binary logistic regression analysis showed that sepsis after NEC (odds ratio [OR] 3.748, 95% confidence interval [CI] 1.171–11.998, P = 0.03), the need to use transfusion of blood products after diagnosis of NEC (OR 8.003, 95% CI 2.365–27.087, P = 0.00), and the need of longer time for nasogastric suction were risk factors for stage II NEC progressing to stage III (OR 1.102, 95% CI 1.004–1.21, P = 0.04).Broad-spectrum antibiotic plus metronidazole may not prevent the deterioration of NEC in full-term and near-term infants. Those infants who had sepsis required transfusion of blood products, and needed longer time for nasogastric suction after stage II NEC was more likely to progress to stage III.

Necrotizing enterocolitis in a full term infant

“…Recent studies assessed the effectiveness of broad spectrum antibiotics in conjunction with Metronidazole to prevent the deterioration of NEC from stage II to III in full term and near term infants. Studies show that infants with stage II NEC are more likely to progress onto stage III if they are short on colostrum feeding, require fresh frozen plasma or cryoprecipitate transfusions or have an elevated C-reactive protein [2,4]. Additionally, they found that the rate of deterioration from stage II NEC to stage III NEC did not vary significantly between the group of infants who were treated with Metronidazole and the group of those who were not, and that the mortality rates in both groups was similar [2].…”

“…Studies show that infants with stage II NEC are more likely to progress onto stage III if they are short on colostrum feeding, require fresh frozen plasma or cryoprecipitate transfusions or have an elevated C-reactive protein [2,4]. Additionally, they found that the rate of deterioration from stage II NEC to stage III NEC did not vary significantly between the group of infants who were treated with Metronidazole and the group of those who were not, and that the mortality rates in both groups was similar [2]. Therefore, these studies suggest that broad spectrum antibiotics administered along with Metronidazole may not prevent deterioration from stage II to stage III in full-term and near term infants.…”

“…Overall mortality for NEC ranges from 20 to 40% [1][2][3][4]. Ninety percent of the affected infants are born preterm, with an age of onset inversely related to gestational age at birth.…”

Antimicrobial Stewardship for Newborns in the Neonatal Intensive Care Unit

“…31 Broad-spectrum antibiotics have not been shown to decrease the progression of NEC. 32 Autmizguine et al 33 compared NEC treatment with anaerobic coverage in low-birthweight infants in 348 NICUs across the United States. In patients with medical NEC, there was no difference in death or intestinal strictures, in fact, there was an increase in intestinal strictures in infants who received anaerobic antimicrobial therapy.…”

Broad-spectrum Antibiotic Plus Metronidazole May Not Prevent the Deterioration of Necrotizing Enterocolitis From Stage II to III in Full-term and Near-term Infants

“…In the article “Broad-spectrum Antibiotic Plus Metronidazole May Not Prevent the Deterioration of Necrotizing Enterocolitis From Stage II to III in Full-term and Near-term Infants: A Propensity Score-matched Cohort Study”, 1 which appeared in Volume 94, Issue 42 of Medicine , the affiliations were incorrectly given in the original article. The article has since been corrected online.…”