Last week, Modern Healthcare published an article discussing the use of antibiotics in preterm infants, saying that providers should do more to identify preemies who are truly at low risk of developing sepsis.
Sepsis refers to the presence of a bacteria in the blood. Infants with sepsis tend to appear ill – they are lethargic, gray in appearance, feed poorly, develop respiratory distress, and drop their body temperatures. Despite these signs, sepsis in a newborn can be difficult to diagnose. And, if not treated promptly, sepsis may cause long-term developmental delay or death.
What is the problem?
Preterm infants are at much higher risk of sepsis as their immature immune systems lack the fighting capacity of a full-term newborn. Because the prognosis of sepsis is so severe, many providers tend to treat first and ask questions later.
Many providers “preemptively administer antibiotics to premature infants as a means of staving off infections,” like sepsis, meningitis, skin and urinary tract infections, and pneumonia. But questions have been raised as to whether this practice may do more harm than good.
Here are the facts:
- 1 in 90 very-low-birth-weight (VLBW*) infants develop sepsis .
- Sepsis kills up to 50% of babies born 22 – 24 weeks who develop infection.
- Although VLBW infants have a higher risk for sepsis, the rate of antibiotic initiation far exceeds the actual incidence of infection.
“At least 30% of antibiotics in the United States are unnecessary, according to the Centers for Disease Control and Prevention.”
Overprescription of Antibiotics in Preemies
In May of 2018, JAMA Network Open published an article analyzing the use of antibiotics in more than 40,000 premature infants from nearly 300 hospitals. Results of this study concluded that despite increased hospital efforts to reduce antibiotic therapy, “providers administered antibiotics to 78% of [VLBW] infants within 3 days of birth and 87% of infants with [ELBW**]”. These infants were also exposed to prolonged use of antibiotics, which is considered to be antibiotic therapy for more than 5 days.
A study from the journal of Nature Microbiology, published in 2016, found evidence that antibiotic therapy results in the growth of antimicrobial-resistant bacteria in the preterm gut, placing these critically ill infants at risk for antibiotic-resistant infections, chronic lung disease, necrotizing enterocolitis and death.
What can we do?
As the parent of a preemie, you serve as your child’s voice. Stand strong and be their advocate. Ask your child’s neonatologist:
- Why do you feel these antibiotics are necessary?
- What clinical signs of sepsis does my baby have?
- How long to expect treatment to last?
- Are there any alternative treatments aside from initiating antibiotics?
As with all medical intervention, the good must outweigh the bad. Remember that antibiotics save lives. If your infant’s doctor is truly concerned for sepsis, allow their medical expertise to guide your decision making.
As a neonatal healthcare provider, be cognizant of how often you’re ordering antibiotics for your tiny patients. Take care to identify premature infants that are at low-risk of developing sepsis to prevent unnecessary antibiotic exposure. Serve as leaders of antibiotic stewardship, encouraging fellow providers to limit antibiotic exposure in babies without significant suspicion of sepsis.
“It is therefore the responsibility of individuals who prescribe antibiotics to premature infants to ensure, to the best of their ability, that treatment is only administered to those who need it.” – Dr. Matthew Bizzarro, Yale University
*VLBW = very-low-birth-weight less than 3 pounds 5 ounces or 1500 grams
**ELBW = extremely-low-birth-weight less than 2 pounds 2 ounces or 1000 grams