Abstract
Background: Antibiotics are widely prescribed by obstetricians, which exposes a large number of infants to antenatal antibiotics (AAB). The effect of AAB on various aspects of neonatal development of preterm infants remains unclear.Methods: In this retrospective study, infants born with gestational age (GA) between 22 +0 and 36 +6 weeks at our unit from 2017 to 2019 were included. Multivariable analysis was adopted to examine the associations between AAB exposure and various outcomes related to enteral feeding process, body growth, and neonatal infection after adjusting for potential confounders. Further subanalysis on the exposure level of AAB and stratified analysis by GA (<34 vs. ≥34 weeks) were also conducted.Results: In this cohort comprising 2,543 preterm infants, AAB was associated with decreased risks of feeding intolerance (odds ratio [OR]: 0.63, 95% confidence interval [CI]: 0.48–0.82) and neonatal infection (OR: 0.63, 95% CI: 0.41–0.94). Higher AAB exposure level was associated with higher Z scores of birth weight (β = 0.37, 95% CI: 0.27–0.47), but lower Δbodyweight Z-scores (β = −0.20, 95% CI: −0.27 to −0.13). AAB was positively associated with the parameters related to body growth in infants with GA <34 weeks but negatively associated in those with GA ≥34 weeks.Conclusions: AAB exposure affects the enteral feeding process and neonatal infection. The effects on body growth vary by the exposure level of AAB and GA of infants. A well-designed prospective and preferably multi-centre study with predefined parameters is required to confirm our findings.
Highlights
Up to 40% of women receive antibiotics during pregnancy [1] mainly for treating infection of Group B streptococci (GBS), premature rupture of membranes (PROM), and prolonging pregnancy [2]
A report has shown that antenatal antibiotic (AAB) exposure is associated with higher risk of gut-related morbidities in preterm infants, including necrotising enterocolitis (NEC) [6, 7]
The AAB infants had a trend toward higher incidence of feeding intolerance than the No AAB ones (25.1 vs. 21.9%, p = 0.06), significantly slower advancement of enteral feeding, and higher incidence of attaining full enteral feeding before discharge (70.1 vs. 66.2%, p = 0.04)
Summary
Up to 40% of women receive antibiotics during pregnancy [1] mainly for treating infection of Group B streptococci (GBS), premature rupture of membranes (PROM), and prolonging pregnancy [2] This results in a large number of neonates having been exposed to antibiotics before birth. AAB affects the colonization of the fetal and neonatal gut, thereby compromising the gut microbiome in preterm infants [8] This compromised gut microbiome is involved in impaired gut development [9] and NEC, affecting the progress of enteral feeding [10] and, body growth. How AAB exposure affects enteral feeding, body growth, and infection in preterm infants remains inconclusive. The effect of AAB on various aspects of neonatal development of preterm infants remains unclear
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