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Weighing the risks: Antibiotic use in very low-birth-weight babies

January 18, 2017
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Antibiotics are the most commonly prescribed class of medications in the neonatal intensive care unit (NICU) for good reason: in preterm infants, infections are difficult to diagnose and can quickly become life-threatening.

New research from BC Children’s Hospital and UBC is improving our understanding of the use of these medications and shedding light on the risks associated with giving these medications to very low-birth-weight infants who do not have a diagnosed infection. The study was published in the December 2016 issue of JAMA Pediatrics.

“To our knowledge, this study is the largest to date that evaluates antibiotic use patterns in NICUs across Canada with a focus on short-term outcomes,” says Dr. Joseph Ting, the lead author of the study. “Our key message is that, while antibiotics are necessary and life-saving treatment for many infants, we need to be aware that they are not completely benign, and, thus they should be used judiciously in preterm infants.”

Dr. Ting is an Investigator at BC Children’s, neonatologist at BC Women’s Hospital & Health Centre, and a Clinical Assistant Professor with the UBC Faculty of Medicine. BC Children’s and BC Women’s are agencies of the Provincial Health Services Authority.

Very low-birth-weight infants weigh less than 1.5 kg (3.3 lbs) when they are born. Most of the infants in this study were born extremely preterm (before 28 weeks of pregnancy) or very preterm (after 28 to 32 weeks of pregnancy). Preterm babies often require assistance with breathing and feeding, and are at risk for a wide-range of complications including chronic lung disease, bleeding in the brain, damaged bowels and heart problems.

Dr. Ting and his research team found that 85 per cent of the 13,738 infants included in the study received antibiotics during their hospital stay.

Doctors in the NICU often prescribe antibiotics when they suspect an infant may have an infection because infections are difficult to diagnosis and can quickly become life-threatening. Diagnostic tests either take too long or are not sensitive enough for these tiny patients. In addition, infections are often difficult to differentiate from other non-infectious diseases.

Researchers found that many infants received antibiotics without a confirmed infection or a diagnosis of necrotizing enterocolitis, a disease characterized by infection and inflammation in the intestines.

“Likely these infants fell into a gray area: because of the seriousness of their condition they needed urgent treatment but doctors could not confirm empirically that they had an infection,” says Dr. Ting.   

Researchers found that this group of infants – those given antibiotics without a confirmed infection or necrotizing enterocolitis diagnosis – were at increased risk for complications associated with prematurity, such as the abnormal growth of blood vessels in the eye.

In addition, the study showed that overall antibiotic use in very low-birth-weight infants declined from 19 per cent in 2010 to 13.8 per cent in 2014.

“We found that the overall decline in antibiotic use happened in parallel with decreasing infection rates,” says Dr. Ting. “This is good news for preterm infants because it indicates that neonatologists across Canada are cautious in prescribing antibiotics and they carefully weigh the risks and benefits.”

Previous research has found that excessive or inappropriate antibiotic use can disturb healthy gut bacteria and has linked this medication with the emergence of antibiotic resistant organisms.

Dr. Ting and his colleagues at BC Children’s and BC Women’s are now investigating the impact of antibiotic use on infant neurodevelopment.

Funding:

Dr. Joseph Ting’s research is supported by BC Children’s Hospital Foundation. This study was supported by the Canadian Neonatal Network Coordinating Centre which is supported by the Canadian Institutes of Health Research and Mount Sinai Hospital.

Key Collaborators:

  • Dr. Joseph Ting, Investigator, BC Children’s; Neonatologist, BC Women’s; and Clinical Assistant Professor, Division of Neonatology, Department of Pediatrics, UBC.
  • Dr. Ashley Roberts, Investigator and Director of the Pediatric Infectious Diseases Fellowship Training Program, BC Children’s; Medical Director, Antimicrobial Stewardship Program, Provincial Health Services Authority; and Clinical Assistant Professor, Division of Pediatric Infectious Diseases, Department of Pediatrics, UBC.
  • Dr. Anne Synnes, Investigator, BC Children’s; Neonatologist, BC Women’s, Neonatal Follow-up Clinic; and Clinical Professor, Division of Neonatology, Department of Pediatrics, UBC.
  • Dr. Simon Dobson, Investigator and Infectious Disease Specialist, BC Children’s; and Clinical Associate Professor and Head, Division of Pediatric Infectious Diseases, Department of Pediatrics, UBC.

Read More:
Ting JY, Synnes A, Roberts A, Deshpandey A, Dow K, Yoon EW, Lee KS, Dobson S, Lee SK, Shah PS; Canadian Neonatal Network Investigators. Association Between Antibiotic Use and Neonatal Mortality and Morbidities in Very Low-Birth-Weight Infants Without Culture-Proven Sepsis or Necrotizing Enterocolitis. JAMA Pediatr. 2016 Dec 1;170(12):1181-1187. doi: 10.1001/jamapediatrics.2016.2132.