We aimed to evaluate the association between initial empirical antibiotic therapy (IEAT) and necrotizing enterocolitis (NEC) in very preterm infants at different early onset sepsis (EOS) risk. This prospective, observational, multi-center study enrolled very low birth weight (VLBW) infants of 5 days) and NEC cumulative incidence, and death was considered as a competing risk. Finally, restricted cubic spline (RCS) models were used to further examine the relationship between time-varying antibiotic exposure and the risk of NEC. Of the 11678 included infants, 2767 infants were categorized as low risk for EOS. In the whole cohort and the infants with non-low-risk EOS, IEAT < 3 days showed a significantly lower risk of NEC (adjusted sHR 0.36, 95% CI 0.19,0.68; (adjusted sHR 0.40, 95% CI 0.21, 0.79) and IEAT for 3–5 days showed a lower risk of NEC (adjusted sHR 0.69, 95% CI 0.52, 0.94; adjusted sHR 0.72, 95% CI 0.5, 1.03), compared with those with No-IEAT. In the infants with low-risk EOS, there was no significant association between the duration of IEAT and the incidence of NEC. The RCS analysis showed a positive linear relationship between the duration of IEAT and the risk of NEC in very preterm infants at different EOS risk. Competing-risk analysis showed that NEC risk may be inversely associated with short-term IEAT in the whole cohort and the non-low-risk EOS group. Notably, the risk of NEC tended to be higher with prolonged IEAT duration in very preterm infants at different EOS risk. These associational findings are exploratory and warrant further investigation.
Li et al. (Tue,) studied this question.
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