Antibiotic Treatments and Patient Outcomes in Necrotizing EnterocolitisFunding None.
Objective This study aimed to examine the impact of different antibiotic treatments on necrotizing enterocolitis (NEC) outcomes.
Study Design Patient outcomes, including total parenteral nutrition and hospitalization durations, abdominal surgeries, intestinal strictures, and mortality data, were analyzed and compared by various antibiotic groups and treatment durations for 160 NEC patients managed at the Women and Children's Hospital of Buffalo between 2008 and 2016.
Results Fourteen different antibiotics were used for NEC, most commonly ampicillin, gentamicin, and metronidazole (AGM). Medical (vs. surgical) NEC patients more likely received AGM (37 vs. 6%, p < 0.001). Surgical (vs. medical) NEC patients more likely received vancomycin (80 vs. 30%, p < 0.001) and antipseudomonal agents (69 vs. 15%, p < 0.001). For medical NEC there were no outcome differences between patients receiving only AGM versus those receiving other treatments; in patients receiving AGM, there were no outcome differences in durations of ≤10 days versus longer courses.
Conclusion Antibiotic use for NEC varies substantially without definite outcome differences. Particularly with medical NEC, AGM for ≤10 days had comparable outcomes to other treatments. In light of growing concern for short and longer term adverse effects with early-life antibiotic exposure, narrow-spectrum and shorter course NEC treatment may be preferred.
* Catherine Murphy’s current affiliation is Pediatrics Residency Program, New York Medical College, Valhalla, New York.
Received: 18 January 2019
Accepted: 06 June 2019
15 July 2019 (online)
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- 1 Lim JC, Golden JM, Ford HR. Pathogenesis of neonatal necrotizing enterocolitis. Pediatr Surg Int 2015; 31 (06) 509-518
- 2 Neu J. Necrotizing enterocolitis: the mystery goes on. Neonatology 2014; 106 (04) 289-295
- 3 Hall NJ, Eaton S, Pierro A. Royal Australasia of Surgeons Guest Lecture. Necrotizing enterocolitis: prevention, treatment, and outcome. J Pediatr Surg 2013; 48 (12) 2359-2367
- 4 Thakkar HS, Lakhoo K. Necrotizing enterocolitis. Surgery (Oxford) 2016; 34 (12) 617-620
- 5 Kastenberg ZJ, Sylvester KG. The surgical management of necrotizing enterocolitis. Clin Perinatol 2013; 40 (01) 135-148
- 6 Coggins SA, Wynn JL, Weitkamp J-H. Infectious causes of necrotizing enterocolitis. Clin Perinatol 2015; 42 (01) 133-154 , ix
- 7 Valpacos M, Arni D, Keir A. , et al. Diagnosis and management of necrotizing enterocolitis: an international survey of neonatologists and pediatric surgeons. Neonatology 2018; 113 (02) 170-176
- 8 Blackwood BP, Hunter CJ, Grabowski J. Variability in antibiotic regimens for surgical necrotizing enterocolitis highlights the need for new guidelines. Surg Infect (Larchmt) 2017; 18 (02) 215-220
- 9 Zani A, Eaton S, Puri P. , et al; EUPSA Network. International survey on the management of necrotizing enterocolitis. Eur J Pediatr Surg 2015; 25 (01) 27-33
- 10 Downard CD, Renaud E, St Peter SD. , et al; 2012 American Pediatric Surgical Association Outcomes Clinical Trials Committee. Treatment of necrotizing enterocolitis: an American Pediatric Surgical Association Outcomes and Clinical Trials Committee systematic review. J Pediatr Surg 2012; 47 (11) 2111-2122
- 11 Solomkin JS, Mazuski JE, Bradley JS. , et al. Diagnosis and management of complicated intra-abdominal infection in adults and children: guidelines by the Surgical Infection Society and the Infectious Diseases Society of America. Clin Infect Dis 2010; 50 (02) 133-164
- 12 WHO Recommendations on Newborn Health. The WHO Guidelines Review Committee/The World Health Organization Website (published 2017). Available at: http://www.who.int/maternal_child_adolescent/documents/newborn-health-recommendations/en/ . Accessed 2018
- 13 Bell MJ, Ternberg JL, Feigin RD. , et al. Neonatal necrotizing enterocolitis. Therapeutic decisions based upon clinical staging. Ann Surg 1978; 187 (01) 1-7
- 14 Kliegman RM, Walsh MC. Neonatal necrotizing enterocolitis: pathogenesis, classification, and spectrum of illness. Curr Probl Pediatr 1987; 17 (04) 213-288
- 15 McNeil J, Hulten KG, Mason EO, Kaplan SL, Vallejo JG. Bacteremic Staphylococcus aureus osteoarticular infections: observations on treatment and outcomes in a population with a high prevalence of methicillin-resistant Staphylococcus aureus (MRSA). Open Forum Infect Dis 2016; 3 (Suppl. 01) 673
- 16 Schulman J, Dimand RJ, Lee HC, Duenas GV, Bennett MV, Gould JB. Neonatal intensive care unit antibiotic use. Pediatrics 2015; 135 (05) 826-833
- 17 Shah D, Sinn JK. Antibiotic regimens for the empirical treatment of newborn infants with necrotising enterocolitis. (Review) Cochrane Database Syst Rev 2012; 8 (08) CD007448-CD007467
- 18 Hansen TN, Ritter DA, Speer ME, Kenny JD, Rudolph AJA. A randomized, controlled study of oral gentamicin in the treatment of neonatal necrotizing enterocolitis. J Pediatr 1980; 97 (05) 836-839
- 19 Faix RG, Polley TZ, Grasela TH. A randomized, controlled trial of parenteral clindamycin in neonatal necrotizing enterocolitis. J Pediatr 1988; 112 (02) 271-277
- 20 Autmizguine J, Hornik CP, Benjamin Jr DK. , et al; Best Pharmaceuticals for Children Act—Pediatric Trials Network Administrative Core Committee. Anaerobic antimicrobial therapy after necrotizing enterocolitis in VLBW infants. Pediatrics 2015; 135 (01) e117-e125
- 21 Cotten CM. Adverse consequences of neonatal antibiotic exposure. Curr Opin Pediatr 2016; 28 (02) 141-149
- 22 Schulfer A, Blaser MJ. Risks of antibiotic exposures early in life on the developing microbiome. PLoS Pathog 2015; 11 (07) e1004903
- 23 Infectious Diseases Management Program. Necrotizing enterocolitis antibiotic selection & duration of therapy. Infectious Diseases Management Program/University of California San Francisco website. Published 2016. Available at: https://idmp.ucsf.edu/necrotizing-enterocolitis-antibiotic-selection-duration-therapy . Accessed 2017
- 24 Cotten CM, Taylor S, Stoll B. , et al; NICHD Neonatal Research Network. Prolonged duration of initial empirical antibiotic treatment is associated with increased rates of necrotizing enterocolitis and death for extremely low birth weight infants. Pediatrics 2009; 123 (01) 58-66
- 25 Alexander VN, Northrup V, Bizzarro MJ. Antibiotic exposure in the newborn intensive care unit and the risk of necrotizing enterocolitis. J Pediatr 2011; 159 (03) 392-397
- 26 Esmaeilizand R, Shah PS, Seshia M, Yee W, Yoon EW, Dow K. Canadian Neonatal Network Investigators. Antibiotic exposure and development of necrotizing enterocolitis in very preterm neonates. Paediatr Child Health 2018; 23 (04) e56-e61