Early Use of Antibiotic For Preterm Infants Increases Risk of Health Problems, Death: Study

Giving very premature infants antibiotics in the first few weeks of life increases their risk of suffering from a serious lung condition, and may also put them at a greater risk of dying, according the findings of a new study.

In a report published in the medical journal JAMA Network Open on June 27, Chinese researchers warn that very premature infants who were given antibiotics after birth had a 23% increased risk of developing bronchopulmonary dysplasia (BDP), and more infants receiving the antibiotics died than other preemies that did not receive the drugs.

BPD is a type of chronic lung disease that affects newborns. It often occurs among preemies whose lungs did not develop correctly during pregnancy. Most infants who have the condition need oxygen therapy and suffer side effects like difficulty breathing and wheezing. Many will have long-term breathing problems throughout childhood.

Preemies also face a higher risk of getting infections after birth, because of their immature immune systems. They often need life support after birth and face a greater risk of getting sepsis, so many doctors will treat preemies with antibiotics shortly after birth as a safeguard.

The American Academy of Pediatrics recommends doctors stop antibiotic therapy 48 hours after birth if blood work is normal, but that often doesn’t happen, researchers say. And many preemies end up receiving prolonged courses of antibiotics even when they face a low risk of sepsis or other infections.

For those reasons, a researcher team from China, led by Dr. Wei Chi, focused on the risk preemies faced when given antibiotics early in life. They studied more than 27,000 very premature infants from 2019 to 2021, using data from the Chinese Neonatal Network, looking at data on infants born at less than 32 weeks of pregnancy or who had a birth weight of less than 1,500 grams with a low risk of developing sepsis.

The preemies were separated into three groups: no antibiotics given during the first week of life, antibiotics given for one to four days during the first week, and antibiotics given for five to seven days. Overall, about 78% of infants received antibiotics for any length of time. More than 60% were given antibiotics for more than five days.

Among infants given antibiotics, nearly 80% were given broad-spectrum antibiotics.

According to the findings, taking antibiotics for five to seven days was linked with a 40% increased risk of moderate to severe BPD and death in preemies, compared to taking a short-term course of less than four days. Preemies who received a short dose of antibiotics of one to four days faced a 23% increased risk of BPD or death when compared to infants who didn’t receive any antibiotics.

Researchers also noted any exposure to antibiotics was linked with a 27% greater risk of suffering BPD or facing death.

The data indicates that premature infants given antibiotics face an increased risk of serious lung conditions and possible death. Researchers warn that preemies given antibiotics early in life should be closely monitored for side effects and to prevent death. Infants who face a low risk of developing sepsis or other infections should not be given antibiotics and should be monitored instead in an effort to prevent antibiotic overuse among infants.

“Prolonged treatment with broad-spectrum antibiotics in these infants is associated with a heightened risk of developing moderate to severe BPD or mortality,” Wei’s team concluded. “This finding underscores the importance of cautious antibiotic use, especially in the early life stages of vulnerable populations.”

Antibiotic Overuse

Antibiotic overuse has become a serious public health concern in recent years. A 2023 United Nations Environment Program report warned the overuse of antibiotics leads to the creation of antibiotic-resistant superbugs that cause millions of deaths around the world each year.

Research published in the journal Pediatrics in 2022 indicates many ER doctors often prescribe antibiotics to children for conditions that cannot be treated by antibiotics. And other studies indicate suspected cases of pneumonia show no benefit when treated with antibiotics. Another study published by researchers from Stanford University indicated antibiotics are often overused in neonatal intensive care units (NICUs).

Another study published in 2022 by researchers from the Children’s Hospital of Philadelphia Newborn Care echoed those findings and indicated more than 90% of infants who face no risk of sepsis are often given antibiotics as a preventive measure.

Researchers and health officials alike warn antibiotics should only be used for verified bacterial infections. They do not help treat viral infections and should not be given to treat viruses and other conditions.