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Am J Perinatol 2017; 34(02): 105-110
DOI: 10.1055/s-0036-1584522
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Implementation of an Automatic Stop Order and Initial Antibiotic Exposure in Very Low Birth Weight Infants

Veeral N. Tolia
1   Division of Neonatology, Department of Pediatrics, Baylor University Medical Center and Pediatrix Medical Group, Dallas, Texas
,
Sujata Desai
1   Division of Neonatology, Department of Pediatrics, Baylor University Medical Center and Pediatrix Medical Group, Dallas, Texas
,
Huanying Qin
2   Department of Quantitative Sciences, Baylor Scott & White Health Care System, Dallas, Texas
,
Polli D. Rayburn
1   Division of Neonatology, Department of Pediatrics, Baylor University Medical Center and Pediatrix Medical Group, Dallas, Texas
,
Grace Poon
3   Department of Pharmacy, Baylor Hamilton Heart and Vascular Hospital, Dallas, Texas
,
Karna Murthy
4   Division of Neonatology, Department of Pediatrics, Feinberg School of Medicine, Northwestern University, and the Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
,
Dan L. Ellsbury
5   Center for Research, Education and Quality, MEDNAX Services–Pediatrix Medical Group, Sunrise, Florida
6   Mercy Children's Hospitals and Clinics, Des Moines, Iowa
,
Arpitha Chiruvolu
1   Division of Neonatology, Department of Pediatrics, Baylor University Medical Center and Pediatrix Medical Group, Dallas, Texas
› Author Affiliations
Further Information

Publication History

02 December 2015

11 May 2016

Publication Date:
10 June 2016 (online)

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Abstract

Objective To evaluate if an antibiotic automatic stop order (ASO) changed early antibiotic exposure (use in the first 7 days of life) or clinical outcomes in very low birth weight (VLBW) infants.

Study Design We compared birth characteristics, early antibiotic exposure, morbidity, and mortality data in VLBW infants (with birth weight <= 1500 g) born 2 years before (pre-ASO group, n = 313) to infants born in the 2 years after (post-ASO, n = 361) implementation of an ASO guideline. Early antibiotic exposure was quantified by days of therapy (DOT) and antibiotic use > 48 hours. Secondary outcomes included mortality, early mortality, early onset sepsis (EOS), and necrotizing enterocolitis.

Results Birth characteristics were similar between the two groups. We observed reduced median antibiotic exposure (pre-ASO: 6.5 DOT vs. Post-ASO: 4 DOT; p < 0.001), and a lower percentage of infants with antibiotic use > 48 hours (63.4 vs. 41.3%; p < 0.001). There were no differences in mortality (12.1 vs 10.2%; p = 0.44), early mortality, or other reported morbidities. EOS accounted for less than 10% of early antibiotic use.

Conclusion Early antibiotic exposure was reduced after the implementation of an ASO without changes in observed outcomes.

Keywords

antibiotic stewardship - very low birth weight infants - automatic stop order - NICU
 

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