Frontiers in pediatrics · 2026
Association between early postnatal antibiotic exposure and bronchopulmonary dysplasia in very preterm infants: a meta-analysis.
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Min Cheng, Sui Ying, Chen Qu
Аннотация
OBJECTIVE: Very preterm infants are at high risk of infection due to their immature immune systems, and empirical antibiotic therapy is commonly initiated shortly after birth. However, excessive or unnecessary antibiotic exposure may adversely affect organ development and long-term outcomes. This study aimed to systematically evaluate the association between early postnatal antibiotic exposure and bronchopulmonary dysplasia (BPD) as well as other adverse outcomes in very preterm infants, to provide evidence for optimizing antibiotic stewardship in neonatal care.
METHODS: PubMed, Embase, Wiley Online Library, and the Cochrane Library database were systematically searched from inception to March 2026. Observational cohort studies comparing early postnatal antibiotic exposure with no exposure or short-term exposure were included. The primary outcome was bronchopulmonary dysplasia (BPD), and secondary outcomes included necrotizing enterocolitis (NEC), mortality, and late-onset sepsis (LOS). Meta-analysis was performed using fixed-effects or random-effects models to calculate pooled odds ratios (ORs) with 95% confidence intervals (CIs). Sensitivity analysis and Egger's test were conducted to assess the robustness of the results and potential publication bias. For outcomes with significant publication bias, the trim-and-fill method was applied.
RESULTS: A total of 11 studies was included. Pooled analysis showed that early postnatal antibiotic exposure was associated with an increased risk of BPD (OR = 1.44, 95% CI: 1.12-1.85). In addition, the risks of NEC (OR = 1.18, 95% CI: 1.09-1.28) and mortality (OR = 1.19, 95% CI: 1.05-1.35) were significantly increased, while no statistically significant association was observed for late-onset sepsis (OR = 0.98, 95% CI: 0.71-1.34). Sensitivity analyses indicated that the results were stable. Publication bias was detected for BPD and mortality; after trim-and-fill correction, the BPD result remained robust, whereas the mortality result warrants cautious interpretation.
CONCLUSION: Early postnatal antibiotic exposure is associated with an increased risk of BPD and several adverse outcomes in very preterm infants. Careful assessment of infection risk and optimization of antibiotic initiation and discontinuation strategies may help improve long-term outcomes in this population.
METHODS: PubMed, Embase, Wiley Online Library, and the Cochrane Library database were systematically searched from inception to March 2026. Observational cohort studies comparing early postnatal antibiotic exposure with no exposure or short-term exposure were included. The primary outcome was bronchopulmonary dysplasia (BPD), and secondary outcomes included necrotizing enterocolitis (NEC), mortality, and late-onset sepsis (LOS). Meta-analysis was performed using fixed-effects or random-effects models to calculate pooled odds ratios (ORs) with 95% confidence intervals (CIs). Sensitivity analysis and Egger's test were conducted to assess the robustness of the results and potential publication bias. For outcomes with significant publication bias, the trim-and-fill method was applied.
RESULTS: A total of 11 studies was included. Pooled analysis showed that early postnatal antibiotic exposure was associated with an increased risk of BPD (OR = 1.44, 95% CI: 1.12-1.85). In addition, the risks of NEC (OR = 1.18, 95% CI: 1.09-1.28) and mortality (OR = 1.19, 95% CI: 1.05-1.35) were significantly increased, while no statistically significant association was observed for late-onset sepsis (OR = 0.98, 95% CI: 0.71-1.34). Sensitivity analyses indicated that the results were stable. Publication bias was detected for BPD and mortality; after trim-and-fill correction, the BPD result remained robust, whereas the mortality result warrants cautious interpretation.
CONCLUSION: Early postnatal antibiotic exposure is associated with an increased risk of BPD and several adverse outcomes in very preterm infants. Careful assessment of infection risk and optimization of antibiotic initiation and discontinuation strategies may help improve long-term outcomes in this population.