A new study published in JAMA Network Open has found that repeated antibiotic exposure in very low-birth-weight (VLBW) preterm infants delivered by cesarean section is associated with impaired lung function and increased risk of asthma in early childhood.
The research, based on data from the German Neonatal Network, focused on 3,820 preterm infants born between 22 and 36 weeks of gestation, all weighing under 1,500 grams. All participants were delivered by C-section to isolate the effects of perinatal antibiotic use, and were followed up between the ages of 5 and 7.
Higher Antibiotic Exposure, Worse Lung Function
Researchers grouped children by their level of antibiotic exposure:
- ARS I: Single exposure (maternal surgical antibiotic prophylaxis)
- ARS II: SAP plus postnatal antibiotics
- ARS III: Antenatal, surgical, and postnatal antibiotics
The study found a clear link between higher antibiotic exposure and reduced lung function, as measured by forced expiratory volume in one second (FEV₁) z-scores. Each increase in antibiotic exposure level was linked to a statistically significant drop in FEV₁. Children in the ARS III group were also nearly twice as likely to experience asthma episodes compared to those in the ARS II group.
Potential Impact on Lung Development
Preterm infants already face higher risks for chronic lung conditions due to underdeveloped lungs and common exposure to interventions like oxygen therapy and ventilation. Antibiotics, while often necessary, may further disrupt lung and immune development by altering the infant’s microbiome, especially in C-section deliveries where natural bacterial exposure is reduced.
Study Limitations and Recommendations
The authors cautioned that the study was observational and could not establish causality. Other limitations included a relatively low follow-up rate (23.5%) and the exclusion of children unable to complete lung function tests, such as those with severe developmental conditions.
Despite these limitations, researchers emphasized the importance of antibiotic stewardship in neonatal care. They called for structured prevention programs and closer respiratory monitoring for high-risk infants. While the study mentioned breastfeeding and microbiome health as potential factors, it stopped short of recommending probiotic use.
Conclusion
The findings suggest that repeated antibiotic exposure in preterm, C-section-born infants may contribute to reduced lung function and greater asthma risk later in childhood. Experts say minimizing unnecessary antibiotic use in neonatal care could help protect long-term respiratory health.
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