Association of Neonatal Antibiotic Exposure with Long-Term Growth Trajectory Faltering in Preterm-Birth Children

Yung-Chieh Lin; Chi-Hsiang Chu; Yen-Kuang Lin; Chih-Chia Chen; Li-Wen Chen; Chao-Ching Huang

doi:10.1159/000535946

Association of Neonatal Antibiotic Exposure with Long-Term Growth Trajectory Faltering in Preterm-Birth Children

Neonatology. 2024 Jan 29:1-10. doi: 10.1159/000535946. Online ahead of print.

Authors

Yung-Chieh Lin¹, Chi-Hsiang Chu^{2

3}, Yen-Kuang Lin⁴, Chih-Chia Chen⁵, Li-Wen Chen⁵, Chao-Ching Huang^{5

6}

Affiliations

¹ Department of Pediatrics, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan, drapple@mail.ncku.edu.tw.
² Institute of Statistics, National University of Kaohsiung, Kaohsiung, Taiwan.
³ Department of Statistics, Tunghai University, Taichung, Taiwan.
⁴ Graduate Institute of Athletics and Coaching Science, National Taiwan Sport University, Taoyuan, Taiwan.
⁵ Department of Pediatrics, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
⁶ Department of Pediatrics, College of Medicine, Taipei Medical University, Taipei, Taiwan.

PMID: 38286129
DOI: 10.1159/000535946

Abstract

Introduction: Preterm neonates often receive a variety of duration of antibiotic exposure during admission. The aim of the study was to evaluate whether neonatal antibiotic exposure is relevant with longitudinal growth problems in preterm-birth children.

Methods: This prospective study enrolled 481 infants who were born <32 weeks of gestation, discharged, and longitudinally followed from corrected age (CA) 6-60 months. After excluding 153 infants with blood culture-confirmed bacteremia, necrotizing enterocolitis, severe cerebral palsy, intestinal ostomy, and congenital anomaly, 328 infants were included for analysis. Covariates included perinatal demographics, neonatal morbidities, extrauterine growth restriction, and antibiotic exposure accumulated by term equivalent age. The primary outcome was the anthropometric trajectories in z-score of bodyweight (zBW), body height (zBH), and body mass index (zBMI) from CA 6-60 months.

Results: Antibiotic exposure duration was significantly negatively associated with zBW and zBH at CA 6, 12, and 60 months, and zBMI at CA 60 months. Multivariate generalized estimating equation analyses showed antibiotic exposure duration had significantly faltering z-score increment from CA 6 to 60 months in zBW and zBH (adjusted mean [95% CI]; ΔzBW: -0.021 [-0.041 to -0.001], p = 0.042; ΔzBH: -0.019 [-0.035 to -0.002], p = 0.027) after adjustment. Children with neonatal antibiotic exposure duration >15 days were significantly lower in the mean anthropometric zBW, zBH, and zBMI at CA 6, 12, 24, and 60 months compared with children with neonatal antibiotic exposure ≤15 days (all p < 0.01).

Conclusions: Growth increments were negatively associated with antibiotic exposure duration in preterm neonates implicating that antibiotic stewardship and growth follow-up for preterm neonates are thus warranted.

Keywords: Anthropometric outcome; Antibiotic exposure; Developmental origins of health and disease; Growth trajectory; Very preterm neonates.