Early Use of Antibiotics Is Associated with a Lower Incidence of Necrotizing Enterocolitis in Preterm, Very Low Birth Weight Infants: The NEOMUNE-NeoNutriNet Cohort Study.
Early Use of Antibiotics Is Associated with a Lower Incidence of Necrotizing Enterocolitis in Preterm, Very Low Birth Weight Infants: The NEOMUNE-NeoNutriNet Cohort Study.
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DOI：
10.1016/j.jpeds.2020.06.032
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发表时间：
2020-12
期刊：
影响因子：
--
通讯作者：
Zhou P
中科院分区：
文献类型：
--
作者：
Li Y;Shen RL;Ayede AI;Berrington J;Bloomfield FH;Busari OO;Cormack BE;Embleton ND;van Goudoever JB;Greisen G;He Z;Huang Y;Li X;Lin HC;Mei J;Meier PP;Nie C;Patel AL;Sangild PT;Skeath T;Simmer K;Uhlenfeldt S;de Waard M;Ye S;Ye X;Zhang C;Zhu Y;Zhou P
确定早产极低出生体重儿（VLBW，≤1500 g）出生后3天内开始使用抗生素是否与坏死性小肠结肠炎（NEC）的发生相关。使用来自五大洲13个新生儿重症监护室（NICU）的VLBW婴儿的NEOMUNE-NeoNutriNet队列（n=2831）进行预先计划的统计分析，以研究早期抗生素治疗与后期NEC发展之间的相关性。比较了早期接受抗生素治疗的婴儿和未接受抗生素治疗的婴儿之间的NEC发生率，并对NICU、胎龄、出生体重、性别、分娩方式、产前类固醇、Apgar评分以及肠内营养的类型和开始进行了统计学调整。未接受早期抗生素治疗的婴儿组（n=269）的NEC发生率为9.0%，而其余婴儿组（n=2562）的NEC发生率为3.9%。经NICU（OR 0.57; 95%CI，0.35-0.94，P <0.05）和其他潜在混杂因素（OR 0.25; CI，0.12-0.47，P<0.0001）逐步统计校正后，早期抗生素组的NEC发生率仍较低。在这个大型的早产VLBW婴儿国际队列中，一小部分婴儿在出生后未接受抗生素治疗，但这些婴儿的NEC发生率较高。重要的是要更好地了解变量的作用，如时间，类型和抗生素治疗的NEC发病率，免疫发育，肠道定植和抗生素耐药性在NICU的长度。
To determine whether commencement of antibiotics within 3 postnatal days in preterm, very low birth weight infants (VLBW, ≤1500 g), is associated with the development of necrotizing enterocolitis (NEC). Pre-planned statistical analyses were done to study the association between early antibiotic treatment and later NEC development, using the NEOMUNE-NeoNutriNet cohort of VLBW infants from 13 neonatal intensive care units (NICUs) in five continents (n=2831). NEC incidence was compared between infants who received early antibiotics and those who did not, with statistical adjustments for NICU, gestational age, birth weight, sex, delivery mode, antenatal steroids, Apgar score, and type and initiation of enteral nutrition. The incidence of NEC was 9.0% in the group of infants who did not receive early antibiotics (n=269) versus 3.9% in the remaining infants (n=2562). NEC incidence remained lower in the early-antibiotic group after stepwise statistical adjustments for NICU (OR 0.57; 95% CI, 0.35-0.94, P < .05) and other potential confounders (OR 0.25; CI, 0.12-0.47, P<0.0001). In this large international cohort of preterm VLBW infants, a minor proportion of infants did not receive antibiotics just after birth, yet these infants had a higher incidence of NEC. It is important to better understand the role of variables such as time, type, and length of antibiotic treatment on NEC incidence, immune development, gut colonization, and antibiotic resistance in the NICU.
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