TOPLINE:
Premature infants exposed to multiple courses of antibiotics around the time of birth experience **weaker lung function** and heightened risk for **asthma episodes** by early school age compared to those with lower exposure levels.
METHODOLOGY:
- The study scrutinized **3,820 premature infants** born between **22 and 36 weeks** of gestation with low birth weights (<1500 g) across **58 hospitals** in Germany over an **8-year period** starting January 2009.
- Infants were categorized into three risk groups:
- Low-risk: Exposed via mothers receiving surgical antimicrobial prophylaxis within **30 minutes of delivery**.
- Intermediate-risk: Children exposed to antibiotics both **prenatally** and **postnatally**.
- High-risk: Children exposed within **7 days of delivery**, prenatally, and right before birth.
- The primary outcome assessed was **lung function**, specifically the air exhaled in the first second of forced exhalation measured at ages **5-7 years**. Secondary outcomes included total air exhaled (or **forced vital capacity**) and **asthma episodes** during childhood.
- The analysis focused on **3,109 participants** born via cesarean delivery, with **292** in the low-risk group, **1,329** in the intermediate-risk group, and **1,488** in the high-risk group.
TAKEAWAY:
- Children with **intermediate risk** displayed **poorer lung function**, indicated by decreased forced exhalation in the first-second outcomes (β, −0.31; 95% CI, −0.59 to −0.02; P = .03).
- Those at **high-risk** exhibited lower forced vital capacity scores compared to the intermediate-risk group (β, −0.23; 95% CI, −0.43 to −0.03; P = .02).
- Children facing the **highest antibiotic exposure** showed a significantly elevated risk for early childhood asthma episodes compared to their intermediate-risk counterparts (odds ratio, 1.91; 95% CI, 1.32-2.76; P = .001).
IN PRACTICE:
As articulated by the study authors, “**Early identification of high-risk neonates** may pave the way for targeted strategies that enhance **respiratory health** and optimize long-term health outcomes.”
SOURCE:
This pivotal study was led by **Ingmar Fortmann, MD**, from the **Department of Pediatrics** at the **University Hospital of Schleswig-Holstein** in Lübeck, Germany. It was published online on May 12 in JAMA Network Open.
LIMITATIONS:
The study encountered some constraints, including a **low median follow-up rate** that varied across clinics. Further, researchers lacked precise details on antibiotic dosages. Only infants sufficiently healthy to undergo lung function tests were included, and some with increased antibiotic exposure already exhibited compromised health, potentially affecting the findings.
DISCLOSURES:
One or more authors of the study disclosed receiving financial support from the **Advanced Clinician Scientist Program** and the **Section of Medicine** at the University of Lübeck, as well as personal fees from **Chiesi** and grants from the **German Federal Ministry of Education and Research**. No additional disclosures were reported.
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