Mismanagement of Antibiotics in Neonatal Medicine

Unreasonable use of antibiotics occurs in about 25-30% of the population. The neonatal period is among the highest group where antibiotic abuse occurs, as high as 40% in some hospitals. This is particularly apparent in newborn intensive care units (NICU), where 70-80% of the admitted infants receive antibiotics. The main motive for this is that clinicians suspect neonatal sepsis very frequently, but only about 3-5% or less of the time infants have blood culture proven sepsis. The neonatal sepsis calculator, described some years ago and validated by several studies, is extremely useful in allowing care givers to assess risk factors and combine them with the clinical evaluation of the newborn to make a more adequate decision and decrease utilization of unnecessary antibiotics. On the other hand, nonspecific inflammatory markers, like C-reactive protein (CRP) and procalcitonin (PCT), are relied upon to make clinical decisions about antibiotic initiation and discontinuation. However, they have very bad specificity for early and late neonatal sepsis, and their sensitivity is not very adequate either. Relying on them in suspicion of neonatal sepsis is a “hazardous waste”. Antibiotic abuse is associated with short- and long-term adverse effects. In preterm infants in NICU, length of hospital stay, bronchopulmonary dysplasia, necrotizing enterocolitis and mortality are increased. In addition to this and to the concomitant increase in health care expenditures, there are long lasting consequences of antibiotic misuse in the neonatal period. They include development of antibiotic resistance, with the emergence of multi resistant organisms, and alterations to the microbiota and microbiome. This has been linked to various disease states later in life, such as abnormal brain development, infections during childhood, asthma, obesity, diabetes, atherosclerosis and autoimmune disorders, among others. The need to apply clinical measures to modify current neonatal practices and improve outcomes has never been more urgent.

Keywords: Antibiotics; Abuse; Newborn; Neonatal; Microbiome

Abbreviations: NICU: Newborn intensive care unit; CRP: C-reactive protein; PCT: Procalcitonin; EOBS: Early onset bacterial sepsis; WHO: World Health Organization; NEC: Necrotizing enterocolitis; BPD: Bronchopulmonary dysplasia; AMR: Antimicrobial resistance; NNT: Number needed to treat; SIBEN: Ibero american society of neonatology