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Early, prolonged use of postnatal antibiotics increased the risk of necrotising enterocolitis
  1. C Michael Cotton
  1. Correspondence to C Michael Cotten, Duke University, PO Box 3179, Durham, NC 27710, USA; cotte010{at}

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Are prolonged courses of antibiotics in early postnatal life associated with increased rates of necrotising enterocolits?



Retrospective cohort study within an ongoing multicentre registry.


Nineteen tertiary neonatal units of the National Institute of Child Health and Human Development (NICHD) Neonatal Research Network, USA.


Four thousand and thirty-nine extremely low–birth-weight (ELBW; 401–1000 g) babies born in the centres between 1998 and 2001 who survived 5 days or more were included in the study. Babies with major abnormalities (n=80) and proven sepsis within 72 h of birth were excluded.

Four hundred and forty babies developed necrotising enterocolitis (NEC); 919 babies either died or developed NEC.

Prolonged (>5day) courses of antibiotics were administered to 2147 infants.

Babies who had not received immediate postnatal antibiotics were excluded from the analysis.

Risk factors

Gestational age, small-for-gestational age status, sex, maternal race, 5-min Apgar score, prolonged rupture of membranes, location of birth (outborn and study centre), prenatal steroid treatment, intrapartum antibiotic treatment, maternal hypertension, maternal haemorrhage and multiple birth (table 1).

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Table 1

Risk of NEC, death …

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  • Funding This study received grants from the US NICHD and the NIH, USA.


  • Provenance and peer review Commissioned; internally peer reviewed.