Anaerobic antibiotics may decrease mortality in infants with necrotizing enterocolitis

1. Among very low birth weight infants with surgical necrotizing enterocolitis (NEC), those treated with anaerobic antibiotics had 0.71 times decreased odds of mortality. 

2. Very low birth weight infants treated with anaerobic antibiotics had 1.71 times increased risk of developing intestinal strictures.

Evidence Rating Level: 3 (Average)

Study Rundown: Premature infants often have increased morbidity and mortality due to complications of NEC. This study sought to examine the effect of anaerobic antibiotic therapy on in-hospital death or intestinal strictures in very low birth weight infants (<1500 g) with NEC. Anaerobic antibiotics included metronidazole, clindamycin, cefoxitin, carbapenems, moxifloxacins, piperacillin-tazobactam, ticarcillin-clavulanate, ampicillin-sulbactam, and amoxicillin-sulbactam. In this case control study, infants with surgical NEC who received anaerobic antibiotics had decreased mortality, although they did have an increased risk of intestinal strictures. This study is limited by the lack of randomization; however, these results identify a specific cohort of infants with surgical NEC who may benefit from anaerobic antibiotics.

Click to read the study, published today in Pediatrics

Relevant Reading: Trends in neonatal morbidity and mortality for very low birthweight infants.

In-Depth [retrospective case-control study]: A total of 2780 very low birthweight infants (<1500 g) with medical or surgical NEC from 348 NICUs were included in the study. Among those infants, 1390 had been exposed to anaerobic antimicrobial therapy on the first day of NEC and 1390 had not been exposed. Infants were matched 1:1 based on a propensity score that included several characteristics, such as baseline demographics and NEC severity. Infants were 41% white, 31% African American, 24% Hispanic; they had a mean gestational age of 27 weeks and mean birth weight of 946 g. Overall mortality was 26%, however infants with surgical NEC treated with anaerobic antibiotics had significantly decreased mortality (odds ratio [OR] 0.71; 95% CI 0.52-0.95). Infants exposed to anaerobic antibiotics did have increased risk of intestinal strictures (OR 1.73; 95% CI 1.11-2.72).

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Image: PD

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