Division of Neonatology, Department of Pediatrics, The Children's Hospital of Philadelphia, The University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA.
Optum, Eden Prairie, MN, USA.
J Perinatol. 2018 Sep;38(9):1227-1234. doi: 10.1038/s41372-018-0146-3. Epub 2018 Jun 13.
To characterize the independent association between antibiotic exposure in the first week of life and the risk of bronchopulmonary dysplasia (BPD) or death among very preterm infants without culture-confirmed sepsis.
Retrospective cohort study using the Optum Neonatal Database. Infants without culture-confirmed sepsis born less than 1500 g and less than 32 weeks gestation between 1/2010 and 11/2016 were included. The independent association between antibiotic therapy during the first week of life and BPD or death prior to 36 weeks postmenstrual age (PMA) was assessed by multivariable logistic regression.
Of 4950 infants, 3946 (79.7%) received antibiotics during the first week of life. Rates of BPD or death (41.5% vs. 31.1%, p < 0.001) and the two individual outcomes were significantly higher among antibiotic treated infants. After adjusting for potential confounding variables, antibiotic use in the first week of life was not associated with increased risk of BPD or death (OR 0.96, 95% CI [0.76,1.21]) or BPD among survivors (OR 0.86, 95% CI [0.67,1.09]). Antibiotic use was associated with increased risk of death prior to 36 weeks PMA (OR 3.01, 95% CI [1.59,5.71]), however, secondary analyses suggested this association may be confounded by unmeasured illness severity.
Antibiotic exposure in the first week of life among preterm infants without culture-confirmed sepsis was not independently associated with increased risk of BPD or death.
描述在未经培养证实患有败血症的极早产儿中，出生后第一周接受抗生素治疗与支气管肺发育不良（BPD）或死亡风险之间的独立关联。
使用 Optum 新生儿数据库进行回顾性队列研究。纳入出生体重＜1500g 且妊娠＜32 周、于 2010 年 1 月至 2016 年 11 月间未经培养证实患有败血症的婴儿。采用多变量逻辑回归评估出生后第一周接受抗生素治疗与 36 周校正胎龄（PMA）前发生 BPD 或死亡的独立关联。
在 4950 例婴儿中，3946 例（79.7%）在出生后第一周内接受了抗生素治疗。抗生素治疗组的 BPD 或死亡发生率（41.5% vs. 31.1%，p＜0.001）和两个单独结局的发生率显著高于未接受抗生素治疗组。在调整了潜在混杂因素后，出生后第一周使用抗生素与 BPD 或死亡风险增加无关（OR 0.96，95%CI [0.76,1.21]）或幸存者中 BPD 发生率增加（OR 0.86，95%CI [0.67,1.09]）。然而，抗生素使用与 36 周 PMA 前死亡风险增加相关（OR 3.01，95%CI [1.59,5.71]），但二次分析表明，这种关联可能受到未测量的疾病严重程度的混杂。
在未经培养证实患有败血症的早产儿中，出生后第一周接受抗生素治疗与 BPD 或死亡风险增加无关。
