What is known about neonatal antibiotics:

•  Empiric antibiotics are continued until the confirmation of negative blood culture.
•  Since neonatal sepsis evaluation and antibiotics are often initiated for subtle indications, prompt identification of negative blood culture and subsequent discontinuation of antibiotic treatment in infants with short-lasting symptoms is imperative.
•  Recent guidelines recommend limiting antibiotic administration to 36 hours if the blood culture remains negative and the infant is asymptomatic.
•  In addition to increasing rates of antimicrobial resistance, early-life antibiotic exposure disrupts the developing microbiome, which may contribute to numerous diseases later in life, including diabetes, obesity, inflammatory bowel disease, asthma and allergy.
•  Neonatal antibiotic treatments are associated with mother-newborn separation, longer duration of hospital stay, and reduced breastfeeding rates.

How to talk with patients and parents about using antibiotics in newborns:

• Avoiding unnecessary antibiotics is safe and has advantages for your baby:
  • More time spent close to the
  • Better development of bacterial
  • Absence of catheter means more freedom of movement and allows for better motor exploration.

• Unless we are certain there is a bacterial infection, the risks of using an IV access outweigh the potential benefit. Risks include skin damage due to catheter-related complications or bacterial resistance.

This EAP recommendation is in accordance with Choosing Wisely recommendations of:

• Norway: www.legeforeningen.no/kloke-valg/til-helsepersonell/legeforeningens-anbefalinger/norsk- barnelegeforening/1.antibiotika-til-nyfodte-bor-avsluttes-etter-36-48-timer-dersom-ingen-vekst-i-blodkultur-og-fredelig- klinikk/
• USA: https://downloads.aap.org/AAP/PDF/Choosing%20Wisely/CWNeonatalPerinatal.pdf USA: https://www.aafp.org/pubs/afp/collections/choosing-wisely/277.html
• Germany: https://register.awmf.org/assets/guidelines/024-008l_S2k_Bakterielle_Infektionen_Neugeborene_2021-03.pdf

References:

• Esaiassen E, et al. Antibiotic exposure in neonates and early adverse outcomes: a systematic review and meta- analysis. J Antimicrob Chemother. 2017 Jul 1;72(7):1858-1870. PMID: 28369594
• Giannoni E, Dimopoulou V, Klingenberg C, Navér L, Nordberg V, Berardi A, et al. Analysis of Antibiotic Exposure and Early-Onset Neonatal Sepsis in Europe, North America, and Australia. JAMA Netw Open. 2022 Nov 23;5(11):e2243691. PMID: 36416819
• Stocker M, Klingenberg C, Navér L, Nordberg V, Berardi A, El Helou S, et al. Less is more: Antibiotics at the beginning of life. Nat Commun. 2023 Apr 27;14(1):2423. PMID: 37105958
• Ur Rehman Durrani N, Rochow N, Alghamdi J, Pelc A, Fusch C, Dutta S. Minimum Duration of Antibiotic Treatment Based on Blood Culture in Rule Out Neonatal Sepsis. Pediatr Infect Dis J. 2019 May;38(5): 528–32. PMID: 30169482