Garg Parvesh M, Riddick Robbin, Ansari Md Abu Yusuf, Rebentisch Aubrey, Shetty Avinash, Adams Kristin, Hillegass William, Garg Padma P
Department of Pediatrics/Neonatology, Wake Forest School of Medicine, Winston-Salem, North Carolina.
Department of Pediatrics/Neonatology, University of Mississippi Medical Center, Jackson, Mississippi.
Am J Perinatol. 2025 Aug 4. doi: 10.1055/a-2663-5723.
This study aimed to assess the relationship between placental lesions, antibiotic exposure duration, and necrotizing enterocolitis (NEC) severity in preterm infants.In this single-center, case-control study, 107 infants with NEC and 130 controls were grouped by antibiotic exposure after birth: ≤3 or >3 days.Of 212 infants, 103 (48.5%) received antibiotics for ≤3 days, while 109 (51.5%) received antibiotics for >3 days. Multivariate regression analysis demonstrated that prolonged antibiotic duration (>3 vs. ≤3 days) was significantly associated with increased severity of NEC, with adjusted odds ratios (aORs) of 2.65 (95% confidence interval [CI]: 1.36-5.16; = 0.004) for medical NEC and 3.36 (95% CI: 1.56-7.23; = 0.002) for surgical NEC. However, prolonged antibiotic duration was not significantly associated with overall mortality (aOR = 1.16, 95% CI: 0.58-2.34; = 0.7). Among infants diagnosed with NEC ( = 97), antibiotic duration of >3 days significantly increased the odds of mortality (aOR = 7.34, 95% CI: 1.94-48.3; = 0.011) but was not significantly associated with NEC severity (aOR = 1.20, 95% CI: 0.49-2.94; = 0.7). Among 64 infants with acute histologic chorioamnionitis, 37 (58%) received antibiotics for >3 days. Longer antibiotic exposure was linked to higher risks of medical NEC (79 vs. 38%; = 0.021) and surgical NEC (62 vs. 38%; = 0.021) compared with shorter exposure. In 134 infants with maternal vascular malperfusion (MVM), prolonged antibiotics were also associated with increased risks for medical (60 vs. 36%; = 0.007) and surgical NEC (67 vs. 36%; = 0.007). Concordance between clinical and pathologic chorioamnionitis was moderate (first-order agreement coefficient [AC1] = 0.60), while agreement for pregnancy-induced hypertension versus MVM was minimal (AC1 = 0.07).Prolonged antibiotic exposure (>3 days) in infants with chorioamnionitis or MVM is most likely associated with increased NEC severity. Limiting antibiotic duration may reduce severe NEC risk in preterm infants. · Prolonged antibiotics following birth are associated with NEC severity.. · Infants exposed to chorioamnionitis and receiving prolonged antibiotics are more likely at NEC risk.. · Shorter duration of antibiotics following birth may reduce NEC risk..
本研究旨在评估早产婴儿胎盘病变、抗生素暴露时长与坏死性小肠结肠炎（NEC）严重程度之间的关系。在这项单中心病例对照研究中，107例患NEC的婴儿和130例对照婴儿根据出生后抗生素暴露情况分组：≤3天或>3天。在212例婴儿中，103例（48.5%）接受抗生素治疗≤3天，而109例（51.5%）接受抗生素治疗>3天。多因素回归分析表明，抗生素使用时间延长（>3天与≤3天相比）与NEC严重程度增加显著相关，对于医疗性NEC，调整后的优势比（aOR）为2.65（95%置信区间[CI]：1.36 - 5.16；P = 0.004），对于外科性NEC，aOR为3.36（95% CI：1.56 - 7.23；P = 0.002）。然而，抗生素使用时间延长与总体死亡率无显著关联（aOR = 1.6，95% CI：0.58 - 2.34；P = 0.7）。在诊断为NEC的婴儿中（n = 97），抗生素使用>3天显著增加了死亡几率（aOR = 7.34，95% CI：1.94 - 48.3；P = 0.011），但与NEC严重程度无显著关联（aOR = 1.20，95% CI：0.49 - 2.94；P = 0.7）。在64例患有急性组织学绒毛膜羊膜炎的婴儿中，37例（58%）接受抗生素治疗>3天。与较短暴露时间相比，更长时间的抗生素暴露与更高的医疗性NEC风险（79%对38%；P = 0.021）和外科性NEC风险（62%对38%；P = 0.021）相关。在134例患有母亲血管灌注不良（MVM）的婴儿中，延长使用抗生素也与医疗性（60%对36%；P = 0.007）和外科性NEC风险增加（67%对36%；P = 0.007）相关。临床与病理绒毛膜羊膜炎之间的一致性为中等（一级一致性系数[AC1] = 0.60），而妊娠高血压与MVM之间的一致性极小（AC1 = 0.07）。绒毛膜羊膜炎或MVM婴儿中抗生素暴露延长（>3天）最有可能与NEC严重程度增加相关。限制抗生素使用时间可能降低早产婴儿严重NEC的风险。·出生后抗生素使用时间延长与NEC严重程度相关。·暴露于绒毛膜羊膜炎且接受抗生素治疗时间延长的婴儿患NEC的风险更高。·出生后抗生素使用时间较短可能降低NEC风险。
