Written by Hannah Harp
Spoon Feed
Infants with intrapartum or postpartum exposure to antibiotics have significantly higher risk of respiratory, urinary, and GI infections in early childhood and are significantly more likely to receive an asthma diagnosis later on in life.
Buy now, pay later––the hidden costs of neonatal antibiotic exposure
As we learn more about disruption of the microbiome and immune regulation, it is becoming increasingly clear that dysbiosis is closely associated with infections, immune-mediated illnesses, allergies, and inflammatory disorders. There is evidence that increased administration of antibiotics in early childhood is correlated with increased diagnosis of asthma, juvenile arthritis, obesity, and neurodevelopmental disorders. How are neonates affected when they receive life-saving antibiotics as part of a sepsis rule-out? Are these effects seen even with exposure to intrapartum antibiotics?
This population-based birth cohort study examined whether early-life antibiotic exposure increases the risk of later infections, antibiotic use, and asthma. Term Icelandic children (n=22,393) were grouped by early antibiotic exposure and followed for 2–12 years. Compared to controls, exposed infants had significantly higher rates of infections (IRR 2.04), antibiotic use (IRR 1.25), and asthma diagnoses (HR 1.91; p < 0.001), particularly among those treated in the first week of life. While access to a centralized EMR is a major strength of this study, it only included babies born in Iceland, limiting generalizabilty. Helpful future analyses might consider breastfeeding history and type of antibiotic administered intrapartum (is GBS vs. chorioamnionitis treatment the same?).
How does this change my practice?
Neonatal antibiotics and antibiotics in early infancy are tricky—they may save a kid’s life but likely have deleterious effects on the microbiome, with significant effects on the immune system. Part of antimicrobial stewardship will be revising treatment algorithms for intrapartum fever and protocols for neonatal sepsis rule-out (thank you, EOS calculator!). I’m excited to see if what we’re learning about the microbiome can shape how we deal with consequences of (necessary) antibiotics treatment.
Source
Infant Antibiotic Exposure Is Associated With Increased Risk of Later Childhood Infections, Antibiotic Use and Asthma. Pediatr Infect Dis J. 2025 Jun 4. doi: 10.1097/INF.0000000000004867. Epub ahead of print. PMID: 40472245
Causality?
Not at all. There is no causality here. This is merely association, as this was an observational study.