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TOPLINE:

Premature infants exposed to multiple courses of antibiotics around the time of birth had weaker lung function and a higher risk for asthma episodes by early school age than those with lower exposure. 

METHODOLOGY:

• The study analyzed 3820 premature infants born between 22 and 36 weeks of gestation with low birth weights (< 1500 g); the infants were enrolled from 58 hospitals across Germany over an 8-year period starting in January 2009.
• Researchers divided the infants into three groups: Low-risk, or those exposed via their mothers who were given surgical antimicrobial prophylaxis in the 30 minutes before delivery; intermediate-risk, or children exposed prenatally and after birth; and high-risk, or children who had been exposed within 7 days of delivery prenatally, again at 30 minutes prior to birth, and after birth.
• The primary outcome was the lung function and the amount of air each infant exhaled in the first second of forced exhalation, measured at ages 5-7 years. Secondary outcomes included the total amount of air exhaled or forced vital capacity and asthma episodes during childhood.
• The analysis included 3109 participants born by cesarean delivery, with 292 (9.4%) in the low-risk group, 1329 (42.7%) in the intermediate-risk group, and 1488 (47.9%) in the high-risk group.

TAKEAWAY:

• Children with intermediate risk scores had poorer lung function than those with low risk scores, as shown by lower forced exhalation in one second outcomes (β, −0.31; 95% CI, −0.59 to −0.02; P = .03).
• Those with high-risk antibiotic exposure vs intermediate risk had lower forced vital capacity scores (β, −0.23; 95% CI, −0.43 to −0.03; P = .02).
• Children with the highest level of exposure to antibiotics had a higher risk for early childhood asthma episodes than those with intermediate risk (odds ratio, 1.91; 95% CI, 1.32-2.76; P = .001).

IN PRACTICE:

“Early identification of high-risk neonates may enable targeted strategies to support respiratory health and optimize long-term outcomes,” the study authors wrote.

SOURCE:

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

LIMITATIONS:

The study had a low median follow-up rate that varied across clinics. The researchers did not have details on the dosage of antibiotics. Only children well enough to take lung function tests were included. Infants who received more antibiotics already had poor health status, which may have accounted for some of the findings.

DISCLOSURES:

One or more study authors reported receiving financial support fromthe Advanced Clinician Scientist Program and Section of Medicine at the University of Lübeck, personal fees from Chiesi, and grants from the German Federal Ministry of Education and Research. No other disclosures were reported.

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