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Anaerobic antimicrobial therapy after necrotizing enterocolitis in VLBW infants.

Publication ,  Journal Article
Autmizguine, J; Hornik, CP; Benjamin, DK; Laughon, MM; Clark, RH; Cotten, CM; Cohen-Wolkowiez, M; Smith, PB ...
Published in: Pediatrics
January 2015

OBJECTIVE: To evaluate the effect of anaerobic antimicrobial therapy for necrotizing enterocolitis (NEC) on clinical outcomes in very low birth weight (≤1500 g) infants. METHODS: We identified very low birth weight infants with NEC from 348 US NICUs from 1997 to 2012. Anaerobic antimicrobial therapy was defined by antibiotic exposure on the first day of NEC. We matched (1:1) infants exposed to anaerobic antimicrobial therapy with infants who were not exposed by using a propensity score stratified by NEC severity (medical and surgical). The primary composite outcome was in-hospital death or intestinal stricture. We assessed the relationship between anaerobic antimicrobial therapy and outcome by using a conditional logistic regression on the matched cohort. RESULTS: A total of 1390 infants exposed to anaerobic antimicrobial therapy were matched with 1390 infants not exposed. Mean gestational age and birth weight were 27 weeks and 946 g, respectively, and were similar in both groups. We found no significant difference in the combined outcome of death or strictures, but strictures as a single outcome were more common in the anaerobic antimicrobial therapy group (odds ratio 1.73; 95% confidence interval, 1.11-2.72). Among infants with surgical NEC, mortality was less common with anaerobic antimicrobial therapy (odds ratio 0.71; 95% confidence interval, 0.52-0.95). CONCLUSIONS: Anaerobic antimicrobial therapy was not associated with the composite outcome of death or strictures but was associated with an increase in intestinal strictures. This higher incidence of intestinal strictures may be explained by the fact that death is a competing outcome for intestinal strictures, and mortality was slightly lower in the anaerobic cohort. Infants with surgical NEC who received anaerobic antimicrobial therapy had lower mortality.

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Published In

Pediatrics

DOI

EISSN

1098-4275

Publication Date

January 2015

Volume

135

Issue

1

Start / End Page

e117 / e125

Location

United States

Related Subject Headings

  • Treatment Outcome
  • Pediatrics
  • Male
  • Intestinal Obstruction
  • Infant, Very Low Birth Weight
  • Infant, Newborn
  • Humans
  • Female
  • Enterocolitis, Necrotizing
  • Bacterial Infections
 

Citation

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Autmizguine, J., Hornik, C. P., Benjamin, D. K., Laughon, M. M., Clark, R. H., Cotten, C. M., … Best Pharmaceuticals for Children Act—Pediatric Trials Network Administrative Core Committee, . (2015). Anaerobic antimicrobial therapy after necrotizing enterocolitis in VLBW infants. Pediatrics, 135(1), e117–e125. https://doi.org/10.1542/peds.2014-2141
Autmizguine, Julie, Christoph P. Hornik, Daniel K. Benjamin, Matthew M. Laughon, Reese H. Clark, C Michael Cotten, Michael Cohen-Wolkowiez, P Brian Smith, and P Brian Best Pharmaceuticals for Children Act—Pediatric Trials Network Administrative Core Committee. “Anaerobic antimicrobial therapy after necrotizing enterocolitis in VLBW infants.Pediatrics 135, no. 1 (January 2015): e117–25. https://doi.org/10.1542/peds.2014-2141.
Autmizguine J, Hornik CP, Benjamin DK, Laughon MM, Clark RH, Cotten CM, et al. Anaerobic antimicrobial therapy after necrotizing enterocolitis in VLBW infants. Pediatrics. 2015 Jan;135(1):e117–25.
Autmizguine, Julie, et al. “Anaerobic antimicrobial therapy after necrotizing enterocolitis in VLBW infants.Pediatrics, vol. 135, no. 1, Jan. 2015, pp. e117–25. Pubmed, doi:10.1542/peds.2014-2141.
Autmizguine J, Hornik CP, Benjamin DK, Laughon MM, Clark RH, Cotten CM, Cohen-Wolkowiez M, Smith PB, Best Pharmaceuticals for Children Act—Pediatric Trials Network Administrative Core Committee. Anaerobic antimicrobial therapy after necrotizing enterocolitis in VLBW infants. Pediatrics. 2015 Jan;135(1):e117–e125.

Published In

Pediatrics

DOI

EISSN

1098-4275

Publication Date

January 2015

Volume

135

Issue

1

Start / End Page

e117 / e125

Location

United States

Related Subject Headings

  • Treatment Outcome
  • Pediatrics
  • Male
  • Intestinal Obstruction
  • Infant, Very Low Birth Weight
  • Infant, Newborn
  • Humans
  • Female
  • Enterocolitis, Necrotizing
  • Bacterial Infections