TOP 31 - A Retrospective Review of Antibiotic Duration in Premature Babies with Necrotizing Enterocolitis

Publication Number: 2782.TOP 31

Ariana T. Meltzer-Bruhn, Boston Children's Hospital, Boston, MA, United States; Stephanie H. Kinlay, Boston Children's Hospital, Brookline, MA, United States; Amy E.. O'Connell, Boston Children's Hospital, Boston, MA, United States

Background: Necrotizing enterocolitis (NEC) remains one of the leading causes of morbidity and mortality among premature infants, particularly those with very low birth weight. Antibiotic therapy is central to NEC management, yet there is significant variability in antibiotic regimens, timing, and duration across institutions. The optimal treatment length for medical and surgical NEC remains uncertain, with current recommendations ranging from 7–14 days and varying evidence supporting any particular regimen or duration. Overuse of antibiotics may contribute to antimicrobial resistance and dysbiosis, whereas undertreatment risks disease progression, further complication or recurrence. Standardizing antibiotic duration may improve outcomes and stewardship in this high-risk population.

Objective: To describe antibiotic prescribing patterns for NEC at Boston Children’s Hospital (BCH) and evaluate associations between antibiotic duration and key clinical outcomes and complications among premature infants diagnosed with suspected, confirmed, or NEC totalis.

Design/Methods: We are conducting an IRB approved retrospective cohort study using the BCH data contained in the CHNC (Children’s Hospital Neonatal Consortium) Database. Eligible infants are those born < 37 weeks’ gestation, admitted to the BCH NICU, and treated with ≥ 48 hours of antibiotics for suspected or confirmed NEC between 0–120 days of life. Exclusion criteria include term infants, prior NEC diagnosis, severe immunodeficiency, or palliative care designation. Exposures of interest include (1) antibiotic duration—categorized as short ( < 7 days), intermediate (7–14 days), or prolonged (> 14 days); (2) antibiotic spectrum (broad vs narrow); and (3) timing of initiation relative to diagnosis. The primary outcome is NEC resolution versus recurrence or progression. Secondary outcomes include need for surgery, mortality, sepsis incidence, NICU length of stay, and antibiotic-associated complications. Descriptive statistics will summarize patient and treatment characteristics. Bivariate analyses will compare outcomes by antibiotic duration group. Multivariable logistic regression will assess associations between duration and outcomes, adjusting for confounders including gestational age, birth weight, NEC severity, comorbidities, and management type. Subgroup analyses will explore differences by gestational age, NEC type, antibiotic spectrum, and complication. All analyses will be conducted with significance set at p ≤ 0.05.