Front Pediatr. 2023 Feb 14;11:1112812. doi: 10.3389/fped.2023.1112812.eCollection 2023.

Alain Cuna ^1 2, Michael J Morowitz ^3 4, Venkatesh Sampath ^1 2

Author information

¹Division of Neonatology, Children's Mercy Kansas City, Kansas City, MO United States.

²School of Medicine, University of Missouri-Kansas City, Kansas City, MO United States.

³Division of Pediatric General and Thoracic Surgery, Children's Hospital of Pittsburgh of UPMC, Pittsburgh, PA United States.

⁴School of Medicine, University of Pittsburgh, Pittsburgh, PA, United States.

Abstract

While prompt initiation of antibiotics at birth due to concerns for early onset sepsis is common, it often leads to many preterm infants being exposed to treatment despite negative blood cultures. Such exposure to early antibiotics can impact the developing gut microbiome putting infants at increased risk of several diseases. Necrotizing enterocolitis (NEC), a devastating inflammatory bowel disease that affects preterm infants, is among the most widely studied neonatal disease that has been linked to early antibiotics. While some studies have demonstrated an increased risk of NEC, other studies have demonstrated seemingly contrary findings of decreased NEC with early antibiotics. Studies using animal models have also yielded differing findings of benefit vs. harm of early antibiotic exposure on subsequent NEC susceptibility. We thus sought to conduct this narrative review to help clarify the relationship between early antibiotics exposure and future risk of NEC in preterm infants. Our objectives are to: (1) summarize findings from human and animal studies that investigated the relationship between early antibiotics and NEC, (2) highlight important limitations of these studies, (3) explore potential mechanisms that can explain why early antibiotics may increase or decrease NEC risk, and (4) identify future directions for research.