Rational Use of Antibiotics in Preterm Neonates

Background: Neonates are in high risk of developing blood stream infections because of their immature immune system. This is more in case of low birth weight and preterms who are at a higher risk than full term newborns. It is common practice amongst pediatricians to administer antibiotics to at risk neonates without evidence of clinical or microbiologically proven sepsis which has led to resistance to antibiotics.

Objectives:

1. To manage low infection risk preterms without antibiotics and determine their outcome
2. To find out relation between maternal risk factors, gestational age & birth weight with regard to need for antibiotics

Methods: Inborn Preterm babies with low risk factors for infection were closely monitored without antibiotics. Babies were started on antibiotics only when sepsis was considered. Detailed maternal history with regard to obstetric risk factors was recorded. Gestational age and birth weight were correlated with need for antibiotics. Babies were followed up till discharge or death.

Results: Of 296 babies admitted in NICU during study period, 74 eligible preterms were enrolled. Sixty two (83%) out of 74 did not require antibiotics. There was statistically significant difference in mean birth weight (1.765+0.37kgs) between neonates who required antibiotics and those who did not. (p-value<0.001). There was no significant association of gestational age with need for antibiotics. Maternal obstetric risk factors had significant association with need for antibiotics in the babies (p-value= 0.025). Three babies (4%) who received antibiotics developed NEC as against none in the non-antibiotics group. Only 2(16.3%) out of the 12 babies in antibiotic group had positive blood cultures. Mortality was 4.1%

Conclusion: Preterms with low risk factors can be managed without antibiotics. Need for antibiotics is strongly associated with maternal obstetric risk factors and low birth weight.