Antibiotic Stewardship
Although antibiotics used prophylactically and therapeutically have likely saved millions of newborns over the past century, their widespread use, both antenatally and postnatally, may not be completely benign. Antibiotic-resistant organisms seem to be an exponentially growing problem. Strong associations with biologic plausability based on animal studies of the evolving immune system have been identified between neonatal antibiotic exposure and later health outcomes. Over the past several years, large, multicenter antibiotic stewardship efforts have been underway to more efficiently and effectively use antibiotics in newborn nurseries and neonatal intensive care units (NICUs). In this review, we will (1) describe the importance and current rationale of antibiotic use in newborns; (2) review the extent and variation in antibiotic practice in NICUs; (3) discuss the emergence of resistant organisms in neonatal infections; (4) present evidence identifying the links between antimicrobial exposure and short- and long-term clinical outcomes; and (5) discuss the importance and impact of antibiotic stewardship in this population.
