Ten‐Year Neonatal Intensive Care Cohort of Pulmonary Adaptation Failure: Sepsis Incidence and Antibiotic Treatments

AIM: Pulmonary adaptation failure, a mild neonatal respiratory distress, is diagnosed clinically. Many guidelines recommend antibiotics for all respiratory symptoms to cover potential septicaemia. However, early antibiotic exposure may have long-term adverse effects. We investigated management of neonatal respiratory symptoms compared to incidence of early onset sepsis (EOS) in a 10-year intensive care cohort. METHODS: This population-based observational study included neonates (gestation > 32 weeks) admitted early to intensive care for respiratory distress, suspected infection, or sepsis, between January 2013 and December 2022 at Oulu University Hospital, Oulu, Finland. Clinical data were obtained from hospital databases. RESULTS: During a decade, 79 003 infants were born alive in Northern Finland and 6377 required early intensive care. After database screening with preset diagnoses, 2957 mother-infant-dyads' records were reviewed manually; 513 were excluded and 2444 analysed. Early antibiotic use was common (n = 1575; 64.4%) whereas true EOS was rare (n = 17; 0.7%). Incidences of respiratory symptoms and EOS were 30.9 and 0.215 per 1000 live-born, respectively. CONCLUSION: Empirical antibiotic treatment was common, although mild respiratory symptoms likely did not justify initiation of antibiotics. More precise diagnostics of neonatal clinical entities are required for more judicious antibiotic stewardship, updating future guidelines and preventing bacterial resistance.