Routinely giving antibiotics to preemies can cause immediate, lifelong harm

Preemie 6

 

If you’re wondering whether antibiotics have a dark side, take a look at a report in Science this month called A Delicate Balance – Routinely giving antibiotics to premature babies may do more harm than good.

Preemies are the hospital’s most vulnerable patients. Sometimes weighing less than a pound and protected in cases of clear plastic, preterm birth is the most common cause of death of infants worldwide.

Their underdeveloped immune system is one problem. But it’s compounded by the fact that we’re often fooled by what appears to be good health: “Infants and neonates have a relatively stable system that can maintain itself through quite a bit of stress but ultimately it can fail – suddenly and catastrophically,” says Greg Large, MD, a family physician at the Western Medical Clinic in Brandon, Manitoba.

That’s why, according to Science, the vast majority of the nearly half-million infants born prematurely in the United States are routinely given antibiotics even without evidence of infection, and why they are kept on the drugs even after blood tests say they aren’t sick. Neonatologists do so because they “are unable to shake the fear that a baby may die on their watch.”

Yet this understandable practice of blanket antibiotic dosing is being challenged because “We’re beginning to recognize that the risk of giving that antibiotic may actually outweigh the benefit,” says Josef Neu, a neonatologist at the University of Florida in Gainesville.

The risk is that antibiotics wipe out an infant’s developing gut microbiome: trillions of microbes that synthesize vitamins, prime our immune systems and produce just as many neurotransmitters as the brain. Because preemies “may never truly catch up” the concern is we’re promoting a host of problems later in life such as asthma, autoimmune disease, and adult and even childhood obesity.

But serious problems arise immediately as well. Antibiotics can increase babies’ risk of the very afflictions the drugs aim to protect against – such as fungal infections, late-onset sepsis, and a deadly intestinal disorder called necrotizing enterocolitis. In fact, a seminal 2009 study found that “each additional day of antibiotics significantly increased the odds that a preemie would develop necrotizing enterocolitis or die.”

Moreover, 2- and 3-year-olds with prior antibiotic exposure developed a “who’s-who list of bad gut pathogens … resistant to every antibiotic … tested…. Their guts had basically become a breeding ground for antibiotic-resistant microorganisms … potentially endangering not only themselves, but also the wider population.”

UF’s Dr. Neu hopes to provide hard evidence of these risks by conducting a clinical trial: A random selection of 150 premature infants who would have been given antibiotics automatically will instead be placed in a nontreatment control group. For 2 years, his team will track the microbiomes and health of the preemies. Some of Neu’s colleagues feel uneasy about withholding antibiotics, but he says answers are needed: “What can we do to use these antibiotics more intelligently?”

I asked Dr. Large, a father of 3, if he would enroll his child in such a study. After a long pause he said “I would be willing to consider it. You just have to watch’em real close.”

 

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