Am J Perinatol 2016; 33 - A022
DOI: 10.1055/s-0036-1592393

Are Antibiotics a Risk Factor for the Development of Necrotizing Enterocolitis?

A. Raba 1, A. O’Sullivan 2, J. Miletin 3
  • 1School of Medicine, National University of Ireland, Galway, Ireland, Coombe Women and Infants University Hospital, Dublin, Ireland
  • 2Coombe Women and Infants University Hospital, Dublin, Ireland
  • 3Coombe Women and Infants University Hospital, Dublin, Ireland; Institute for the Care of Mother and Child, Prague, Czech Republic; 3rd School of Medicine, Charles University, Prague, Czech Republic; UCD School of Medicine and Medical Sciences, Dublin, Ireland

Presenter: A. Raba (e-mail: atropine1986@yahoo.com)

Introduction: Previous studies have identified many potential risk factors that are associated with necrotizing enterocolitis (NEC). Concerns have been raised about whether antibiotic therapy is a potential independent risk factor for NEC in premature infants. Therefore, this study was conducted to identify the association between antibiotic exposure and NEC in very low-birth-weight infants (VLBW).

Materials and Methods: We performed a retrospective 1:2 case–control analysis of VLBW infants born between 1/1/2012 and 31/12/2014 in Coombe Women and Infants University Hospital. Every case of NEC ≥ stage IIA according to the modified Bell’s criteria matched to two controls for the gender, gestational age, birth weight, intrauterine growth restriction, mode of delivery and maternal chorioamnionitis. Demographic and clinical characteristics, as well as potential risk factors for NEC were compared between cases and controls.

Results: Twenty-two cases of NEC were matched to 32 controls. A few notable differences were observed between case and control groups. Prolonged exposure to initial antibiotics for more than 5 days was associated with 3.6 times increase risk to have a baby with NEC [OR: 3.6; 95% CI: 1.129–11.478]. The infants who developed NEC were exposed to more frequent number of antibiotic courses (1 [IQR 1–2] day vs. 1 [IQR 0.25–1] day, p = 0.03) and to more days on any antibiotic (5 [IQR 3–10] days vs. 3 [IQR 2–6] days, p = 0.02) compared with those did not have NEC.

Conclusion: Prolonged exposure to initial antibiotics is associated with an increased probability of NEC in VLBW infants. Antibiotics should be used with caution to decrease subsequent serious outcomes. Antibiotic guidelines and stewardship to ensure appropriate antibiotic use are strongly suggested.

Keywords: NEC, necrotizing enterocolitis, VLBW, antibiotics