Department of Pediatrics, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan,
Institute of Statistics, National University of Kaohsiung, Kaohsiung, Taiwan.
Neonatology. 2024;121(3):396-405. doi: 10.1159/000535946. Epub 2024 Jan 29.
Preterm neonates often receive a variety of duration of antibiotic exposure during admission. The aim of the study was to evaluate whether neonatal antibiotic exposure is relevant with longitudinal growth problems in preterm-birth children.
This prospective study enrolled 481 infants who were born <32 weeks of gestation, discharged, and longitudinally followed from corrected age (CA) 6-60 months. After excluding 153 infants with blood culture-confirmed bacteremia, necrotizing enterocolitis, severe cerebral palsy, intestinal ostomy, and congenital anomaly, 328 infants were included for analysis. Covariates included perinatal demographics, neonatal morbidities, extrauterine growth restriction, and antibiotic exposure accumulated by term equivalent age. The primary outcome was the anthropometric trajectories in z-score of bodyweight (zBW), body height (zBH), and body mass index (zBMI) from CA 6-60 months.
Antibiotic exposure duration was significantly negatively associated with zBW and zBH at CA 6, 12, and 60 months, and zBMI at CA 60 months. Multivariate generalized estimating equation analyses showed antibiotic exposure duration had significantly faltering z-score increment from CA 6 to 60 months in zBW and zBH (adjusted mean [95% CI]; ΔzBW: -0.021 [-0.041 to -0.001], p = 0.042; ΔzBH: -0.019 [-0.035 to -0.002], p = 0.027) after adjustment. Children with neonatal antibiotic exposure duration >15 days were significantly lower in the mean anthropometric zBW, zBH, and zBMI at CA 6, 12, 24, and 60 months compared with children with neonatal antibiotic exposure ≤15 days (all p < 0.01).
Growth increments were negatively associated with antibiotic exposure duration in preterm neonates implicating that antibiotic stewardship and growth follow-up for preterm neonates are thus warranted.
早产儿在住院期间通常会接受多种不同时长的抗生素治疗。本研究旨在评估新生儿抗生素暴露与早产儿的纵向生长问题是否相关。
本前瞻性研究纳入了 481 名胎龄<32 周、出院并从校正年龄（CA）6-60 个月进行纵向随访的婴儿。排除了 153 名血培养确诊菌血症、坏死性小肠结肠炎、严重脑瘫、肠造口术和先天性异常的婴儿后，328 名婴儿被纳入分析。协变量包括围产期人口统计学、新生儿合并症、宫外生长受限和累积至胎龄等效年龄的抗生素暴露。主要结局是 CA 6-60 个月时体重（zBW）、身高（zBH）和体质量指数（zBMI）的人体测量学轨迹的 z 评分。
抗生素暴露持续时间与 CA 6、12 和 60 个月时的 zBW 和 zBH，以及 CA 60 个月时的 zBMI 显著负相关。多变量广义估计方程分析显示，抗生素暴露持续时间与 zBW 和 zBH 从 CA 6 到 60 个月的 z 评分增量显著降低（调整后平均[95%CI]；ΔzBW：-0.021[-0.041 至-0.001]，p=0.042；ΔzBH：-0.019[-0.035 至-0.002]，p=0.027）。新生儿抗生素暴露持续时间>15 天的儿童在 CA 6、12、24 和 60 个月时的平均 zBW、zBH 和 zBMI 显著低于新生儿抗生素暴露持续时间≤15 天的儿童（均 p<0.01）。
生长增量与抗生素暴露持续时间呈负相关，这表明需要对早产儿进行抗生素管理和生长随访。
