Archives

  • 2018-07
  • 2019-04
  • 2019-05
  • 2019-06
  • 2019-07
  • 2019-08
  • 2019-09
  • 2019-10
  • 2019-11
  • 2019-12
  • 2020-01
  • 2020-02
  • 2020-03
  • 2020-04
  • 2020-05
  • 2020-06
  • 2020-07
  • 2020-08
  • 2020-09
  • 2020-10
  • 2020-11
  • 2020-12
  • 2021-01
  • 2021-02
  • 2021-03
  • 2021-04
  • 2021-05
  • 2021-06
  • 2021-07
  • 2021-08
  • 2021-09
  • 2021-10
  • 2021-11
  • 2021-12
  • 2022-01
  • 2022-02
  • 2022-03
  • 2022-04
  • 2022-05
  • 2022-06
  • 2022-07
  • 2022-08
  • 2022-09
  • 2022-10
  • 2022-11
  • 2022-12
  • 2023-01
  • 2023-02
  • 2023-03
  • 2023-04
  • 2023-05
  • 2023-06
  • 2023-07
  • 2023-08
  • 2023-09
  • 2023-10
  • 2023-11
  • 2023-12
  • 2024-01
  • 2024-02
  • 2024-03
  • 2024-04

    • AN-2728 Of the infants in the study there were twin deliveri

    2024-01-23

    Of the 580 infants in the study, there were 106 twin deliveries and 10 triplet deliveries. There was no difference in prenatal antibiotic exposure between multiple and singleton births. Nevertheless, analysis of maternal antibiotic use was based on the 309 individual mothers who were provided AN-2728 prenatally (rather than the 362 study infants who also received antibiotics via their mothers prenatally). In the 72 hours before delivery, a total of 534 antibiotic courses were given, which could be grouped into 55 distinct combinations of the 14 different antibiotics that were used. Sixty percent of mothers who received antibiotics had >1 type (, Table II, Table III, Table IV; available at www.jpeds.com). Of the 580 infants studied, 44 (7.5%) developed NEC, 65 (11.1%) developed LOS, 56 (9.6%) died before discharge from the NICU, and 124 (21%) experienced at least 1 of the (combined outcome) of NEC, LOS, or death (). Death was attributable to NEC in 19 cases (34%) and to LOS in 12 cases (21%). Bacterial organisms causing LOS were coagulase-negative Staphylococcus (48%), Klebsiella (10%), E coli (8%), Enterococcus (6%), Group B Streptococcus (5%), methicillin-resistant Staphylococcus aureus (5%), and S aureus (4%), Streptococcus viridans (2%), and 1% each for Pseudomonas, Enterobacter, and Bacillus species. Fungal species accounted for 1% of LOS cases. Neither probiotic therapy nor fluconazole prophylaxis were used routinely in the study NICUs when this cohort was accrued. To adjust for potential confounding, the rates of disease were corrected for gestational age by using infants who did not receive prenatal or high empiric postnatal antibiotics as the comparison group. NEC was diagnosed less commonly among infants with prenatal exposure to antibiotics (3.2%) compared with infants with no prenatal antibiotic exposure (10.5%, P < .001, ). Death rates followed a pattern similar to that of NEC (P = .002). LOS was not significantly different in infants with prenatal exposure (8.2%) compared with infants with no prenatal antibiotic exposure (6.8%, P = .159). Moreover, the combined outcome of NEC, LOS, or death was more common in infants without prenatal antibiotic exposure compared with infants having prenatal antibiotic exposure (P = .012) (). Because maternal indication for use of antibiotics could be a critical factor, we evaluated neonatal outcomes in relation to the maternal circumstances of use. Among all 580 study infants, 33 (5.6%) were born of mothers given antibiotics for prophylaxis of cesarean delivery only; 83 (14.3%) were born of mothers given antibiotic for GBS prophylaxis only; 107 (18.4%) were born of mothers given antibiotic for premature rupture of membranes only; and the remaining 139 (23.9%) infants' mothers were given antibiotics for a combination of indications. Comparing outcomes based on these maternal indication groups (), NEC occurred most frequently in infants without maternal antibiotic exposure (11.4%) and least frequently in infants whose mothers received antibiotics for GBS prophylaxis only (3.6%), but NEC rates were low across all prenatally antibiotic–exposed infants regardless of maternal indication. Similar to NEC, death occurred most frequently in infants without maternal antibiotic exposure (11.9%) and was lower among all prenatally exposed infants regardless of maternal indication. In contrast, LOS occurred least frequently in infants without maternal antibiotic exposure (7.3%), with LOS rates greater regardless of maternal indication for antibiotics. Multiple logistic regression modeling was performed to adjust for potential confounding factors (). Maternal antibiotic use (yes/no) and high empiric infant antibiotic use (yes/no) were included in all models regardless of significance. Repeat data analysis using only patients from singleton births was compared with the analysis of the entire study population, and the results were not affected by the inclusion of the entire cohort (; available at www.jpeds.com).