Multiple antibiotic exposures in early life may have long-term respiratory consequences

Preterm infants with multiple episodes of antibiotic exposure prenatally have a higher likelihood of having impaired lung function at early school age, as shown in a study.

Researchers used data from 58 German Neonatal Network (GNN) centres and looked at 3,820 children who were born preterm and with very low birth weight (VLBW). These children were followed through age 5 to 7 years.

Participants were categorized according to their antibiotic risk score (ARS): ARS I group (low-risk) was only exposed to surgical antimicrobial prophylaxis (SAP) given to the mother before caesarean delivery; ARS II group (intermediate-risk) was exposed to maternal SAP and postnatal antibiotic treatment of the neonate; and ARS III group (high-risk) had all three exposures, specifically antenatal treatment of the mother, SAP, and postnatal antibiotics. 

The primary outcome was the forced expiratory volume in 1 second (FEV1) z-score at 5–7 years of age. Secondary outcomes were forced vital capacity (FVC) z-score and childhood asthma episodes.

The median gestational age of the children was 28.4 weeks, with 51.0 percent being male and 81.4 percent being born by caesarean delivery. A total of 292 children (9.4 percent) were in the ARS I group, 1,329 (42.7 percent) in the ARS II group, and 1,488 (47.9 percent) in the ARS III group.

Compared with ARS I, higher ARS levels were associated with significantly lower FEV1 z-scores at early school age (ARS II: β, −0.31, 95 percent confidence interval [CI], −0.59 to −0.02; p=0.03; ARS III: β, −0.27, 95 percent CI, −0.46 to −0.08; p=0.006).

In the secondary analysis, children in the ARS III group had impaired FVC z-scores (β, −0.23, 95 percent CI, −0.43 to −0.03; p=0.02) and significantly increased risk of early childhood asthma episodes (odds ratio, 1.91, 95 percent CI, 1.32–2.76; p=0.001) compared with those in the ARS II group.

The findings underscore the importance of enabling targeted strategies for high-risk neonates in order to support respiratory health and optimize long-term outcomes.