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TOPLINE:

Neonates born preterm with very low birth weight (VLBW) exposed to multiple perinatal antibiotics were at an increased risk for impaired lung function and asthma episodes at early school age, according to a new study.

METHODOLOGY:

• This population-based, multicentre cohort analysis included 3820 neonates born preterm with VLBW (< 1500 g; median gestational age, 28.4 weeks; 49.0% girls) from 58 German Neonatal Network centres between 2009 and 2017.
• Researchers stratified participants into the following three groups on the basis of the antibiotic risk score (ARS): Low-risk group (ARS I; 9.4%) that received only surgical antimicrobial prophylaxis, intermediate-risk group (ARS II; 42.7%) that received prophylaxis plus postnatal antibiotics, and high-risk group (ARS III; 47.9%) that received additional antenatal maternal treatment.
• The analysis focused on 3109 participants born by caesarean delivery.
• The primary endpoint was the forced expiratory volume in 1 second (FEV1) z score at the ages of 5-7 years; secondary outcomes included the forced vital capacity (FVC) z score and the number of childhood asthma episodes.

TAKEAWAY:

• About 90.6% of VLBW participants born by caesarean delivery received postnatal antibiotics for suspected or confirmed sepsis, and 47.9% had additional antenatal antibiotic exposure.
• Higher ARS levels were significantly associated with lower FEV1 z scores at early school age (P < .001).
• An increased exposure to antibiotics (ARS III vs II) was correlated with impaired FVC z scores (P = .02) and an increased risk for early childhood asthma episodes (odds ratio, 1.91; P = .001).

IN PRACTICE:

"Early identification of high-risk individuals allows for targeted parental counseling and structured prevention strategies. Evidence-based programs and prevention bundles are needed to support respiratory health and optimize long-term outcomes in the vulnerable group of preterm individuals," the authors wrote.

SOURCE:

This study was led by Ingmar Fortmann, MD, University Hospital of Schleswig-Holstein, Campus Lübeck, Lübeck, Germany. It was published online on May 12, 2025, in JAMA Network Open.

LIMITATIONS:

This study had a low and variable follow-up rate, which may have introduced selection bias. Data on antibiotic dosage and duration were not available, and a causal relationship could not be established. Differences in clinical vulnerability between infants with more or fewer antibiotic courses may have influenced the results. Potential confounders such as gut dysbiosis, infections, medication exposure, and systematic inflammation were not considered in the study. Additionally, only children healthy enough to undergo lung function testing were included, potentially resulting in a morbidity bias.

DISCLOSURES:

The German Neonatal Network registry was supported by grants from the German Federal Ministry of Education and Research. Several authors reported receiving support from academic or government programs during the study as well as personal fees, grants, travel support, and honoraria from Chiesi outside the submitted work. Details are provided in the original article.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.