To evaluate if an antibiotic automatic stop order (ASO) changed early antibiotic exposure (use in the first 7 days of life) or clinical outcomes in very low birth weight (VLBW) infants.  We compared birth characteristics, early antibiotic exposure, morbidity, and mortality data in VLBW infants (with birth weight <= 1500 g) born 2 years before (pre-ASO group,  = 313) to infants born in the 2 years after (post-ASO,  = 361) implementation of an ASO guideline. Early antibiotic exposure was quantified by days of therapy (DOT) and antibiotic use > 48 hours. Secondary outcomes included mortality, early mortality, early onset sepsis (EOS), and necrotizing enterocolitis.  Birth characteristics were similar between the two groups. We observed reduced median antibiotic exposure (pre-ASO: 6.5 DOT vs. Post-ASO: 4 DOT;  < 0.001), and a lower percentage of infants with antibiotic use > 48 hours (63.4 vs. 41.3%;  < 0.001). There were no differences in mortality (12.1 vs 10.2%;  = 0.44), early mortality, or other reported morbidities. EOS accounted for less than 10% of early antibiotic use.  Early antibiotic exposure was reduced after the implementation of an ASO without changes in observed outcomes.