Neonatal antibiotic exposure and the risk NEC

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In this issue of The Journal, Alexander et al report a retrospective case control study performed in a single neonatal intensive care unit (NICU) over a 9 year period, assessing potentially relevant exposures from birth to onset of necrotizing enterocolitis (NEC) in cases and from birth to the same postnatal age in controls. Matching controls-to-cases (2:1), investigators controlled for gestational age, birth weight, and year of NICU admission, and assessed 9 possible NEC associations. In multivariate regression analysis, authors found exposure to antibiotics prior to NEC as statistically significant (adjusted OR 1.10; 95% CI 1.02-1.19) and also showed a “dose effect,” with 20% increased probability of NEC per day of antibiotic exposure.

These data add weight to the hypothesis that a segment of the road to NEC may be paved with antibiotics that reduce or alter a naturally protective gut flora. This study underscores that, for abundant reasons, unnecessary or unnecessarily prolonged courses of antibiotics should be routed out aggressively in empiric NICU care. Unfortunately, the nature of the study and lack of use of an illness score make it impossible to know whether the association was due to antibiotic use itself or confounded because of another or additional condition(s) that increased risk of NEC. The refinement of optimal study methodologies for the pathogenesis and prevention of NEC go on.

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