Early Empiric Antibiotic Use Is Associated With Delayed Feeding Tolerance in Preterm Infants

Abstract

The causative factors of neonatal feeding intolerance are poorly understood, but potentially related to clinical practices such as empiric antibiotic usage. The objective of this study was to evaluate whether early empiric antibiotic exposure negatively affects preterm infants' enteral feeding tolerance. Data from infants without risk factors for sepsis, 500 to 1499 g birth weight and 24 to 34 weeks gestational age were analyzed. The primary outcomes were the empiric antibiotic exposure effects on the infants' total parenteral nutrition usage duration and prevalence of necrotizing enterocolitis (NEC). Among the 901 infants included, 67 were exposed to early empiric antibiotic. A 50% increase in parenteral nutrition usage duration and a 4-fold greater prevalence of NEC was seen in the early empiric antibiotic-exposed neonates, when compared with control infants (P < 0.01). Early empiric antibiotic exposure appears to negatively influence preterm infant feeding tolerance and possibly contributes to NEC.

Patterned progression of gut microbiota associated with necrotizing enterocolitis and late onset sepsis in preterm infants: a prospective study in a Chinese neonatal intensive care unit

“…In clinical practices, broad-spectrum antibiotics (the most commonly prescribed medications in the NICU) are recommended to empirically prevent and treat both NEC and LOS (Bury & Tudehope, 2001; Brook, 2008; Kimberlin et al, 2018). However, antibiotics can further induce microbiome dysbiosis that may increase the risk of developing these diseases and exacerbate the severity (Gibson, Crofts & Dantas, 2015; Kuppala et al, 2011; Martinez et al, 2017; Cantey et al, 2018). Our results showed limited differences in bacterial diversity and composition between two case groups and the control group despite continuously antibiotics administration.…”

Peer Review #1 of "Patterned progression of gut microbiota associated with necrotizing enterocolitis and late onset sepsis in preterm infants: a prospective study in a Chinese neonatal intensive care unit (v0.3)"

“…In clinical practices, broad-spectrum antibiotics (the most commonly prescribed medications in the NICU) are recommended to empirically prevent and treat both NEC and LOS (Bury and Tudehope, 2001;Brook, 2008;Kimberlin et al, 2018). However, antibiotics can further induce microbiome dysbiosis that may increase the risk of developing these diseases and exacerbate the severity (Gibson et al, 2015;Kuppala et al, 2011;Martinez et al, 2017;Cantey et al, 2018). Our results showed limited differences in bacterial diversity and composition between two case groups and the control group despite continuously antibiotics administration.…”

Clinical Observation of Extensively Hydrolysis Protein Formula With Feeding Intolerance in Preterm Infants

“…Nowadays, many studies have found high-risk factors associated with FI as follows. (1) Low gestational age, low birth weight, asphyxia, respiratory distress, and enteral feeding delay ( 6 ); (2) premature infant formula feeding ( 8 , 12 ); (3) gut microbiota affected by early antibiotic using ( 25 ); (4) applied Indomethacin or Ibuprofen in the treatment of hemodynamically significant patent ductus arteriosus (hsPDA) ( 26 ); and (5) cow's-milk protein intolerance (CMPI): a subset of premature infant formula fed will develop to FI or recurrence NEC-like illness, such as vomiting, diarrhea, and hematochezia ( 27 , 28 ). It leads to repeated intestinal feeding interruptions and then requires multiple courses of PN.…”