Anaerobic antimicrobial therapy after necrotizing enterocolitis in VLBW infants

Best Pharmaceuticals for Children Act - Pediatric Trials Network Administrative Core Committee

Research output: Contribution to journalArticle

17 Citations (Scopus)

Abstract

OBJECTIVE: To evaluate the effect of anaerobic antimicrobial therapy for necrotizing enterocolitis (NEC) on abstract 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.

Original languageEnglish (US)
Pages (from-to)e117-e125
JournalPediatrics
Volume135
Issue number1
DOIs
StatePublished - Jan 1 2015

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Necrotizing Enterocolitis
Pathologic Constriction
Very Low Birth Weight Infant
Therapeutics
Mortality
Odds Ratio
Confidence Intervals
Propensity Score
Group Psychotherapy
Birth Weight
Gestational Age
Logistic Models
Anti-Bacterial Agents
Incidence

All Science Journal Classification (ASJC) codes

  • Pediatrics, Perinatology, and Child Health

Cite this

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
Best Pharmaceuticals for Children Act - Pediatric Trials Network Administrative Core Committee. / Anaerobic antimicrobial therapy after necrotizing enterocolitis in VLBW infants. In: Pediatrics. 2015 ; Vol. 135, No. 1. pp. e117-e125.
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title = "Anaerobic antimicrobial therapy after necrotizing enterocolitis in VLBW infants",
abstract = "OBJECTIVE: To evaluate the effect of anaerobic antimicrobial therapy for necrotizing enterocolitis (NEC) on abstract 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.",
author = "{Best Pharmaceuticals for Children Act - Pediatric Trials Network Administrative Core Committee} and Julie Autmizguine and Hornik, {Christoph P.} and Benjamin, {Daniel K.} and Laughon, {Matthew M.} and Clark, {Reese H.} and Cotton, {C. Michael} and Michael Cohen-Wolkowiez and Smith, {P. Brian} and Jeffrey Barrett and Berezny, {Katherine Y.} and Edmund Capparelli and Kearns, {Gregory L.} and Andre Muelenaer and O'Shea, {T. Michael} and Ian Paul and {Van Den Anker}, John and Kelly Wade and Walsh, {Thomas J.}",
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Best Pharmaceuticals for Children Act - Pediatric Trials Network Administrative Core Committee 2015, 'Anaerobic antimicrobial therapy after necrotizing enterocolitis in VLBW infants', Pediatrics, vol. 135, no. 1, pp. e117-e125. https://doi.org/10.1542/peds.2014-2141

Anaerobic antimicrobial therapy after necrotizing enterocolitis in VLBW infants. / Best Pharmaceuticals for Children Act - Pediatric Trials Network Administrative Core Committee.

In: Pediatrics, Vol. 135, No. 1, 01.01.2015, p. e117-e125.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Anaerobic antimicrobial therapy after necrotizing enterocolitis in VLBW infants

AU - Best Pharmaceuticals for Children Act - Pediatric Trials Network Administrative Core Committee

AU - Autmizguine, Julie

AU - Hornik, Christoph P.

AU - Benjamin, Daniel K.

AU - Laughon, Matthew M.

AU - Clark, Reese H.

AU - Cotton, C. Michael

AU - Cohen-Wolkowiez, Michael

AU - Smith, P. Brian

AU - Barrett, Jeffrey

AU - Berezny, Katherine Y.

AU - Capparelli, Edmund

AU - Kearns, Gregory L.

AU - Muelenaer, Andre

AU - O'Shea, T. Michael

AU - Paul, Ian

AU - Van Den Anker, John

AU - Wade, Kelly

AU - Walsh, Thomas J.

PY - 2015/1/1

Y1 - 2015/1/1

N2 - OBJECTIVE: To evaluate the effect of anaerobic antimicrobial therapy for necrotizing enterocolitis (NEC) on abstract 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.

AB - OBJECTIVE: To evaluate the effect of anaerobic antimicrobial therapy for necrotizing enterocolitis (NEC) on abstract 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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Best Pharmaceuticals for Children Act - Pediatric Trials Network Administrative Core Committee. Anaerobic antimicrobial therapy after necrotizing enterocolitis in VLBW infants. Pediatrics. 2015 Jan 1;135(1):e117-e125. https://doi.org/10.1542/peds.2014-2141