While preterm infants are frequently exposed to antibiotics after they are three days old due to suspected late-onset infections, there is no consensus surrounding which antibiotics should be prescribed. In a new study, researchers at Children’s Hospital of Philadelphia (CHOP) found a wide range of antibiotics prescribed at 699 hospitals across the country, underscoring the need for more streamlined guidance to optimize treatments for vulnerable patients while also practicing responsible antibiotic use.
The findings were published today in the journal Pediatrics.
Preterm infants are at high risk for infection due to a variety of factors, leading to frequent antibiotic administration in neonatal intensive care units (NICUs). Neonatal late-onset sepsis (LOS) is defined as bacterial or fungal infections occurring beyond 72 hours after birth. LOS affects about 12% of very-low birth weight infants born at or prior to 30 weeks’ gestation and is associated with substantial morbidity and mortality. However, no consensus recommendations to guide antibiotic selection are available, partly due to low-quality evidence and variation among NICU centers.
To address this gap, researchers conducted a retrospective study using the Premier Healthcare Database, a comprehensive electronic healthcare data repository. In total, the study examined data from 420,687 infants who were born at or before 34 weeks’ gestation and admitted to one of 699 NICUs between 2009 and 2023. 65,398 infants (15.5%) were administered late antibiotics and were studied in more detail.
The study found that antibiotic exposure occurred most frequently among extremely preterm infants, with 75% of infants born at 22 to 24 weeks of gestation administered late antibiotics. Researchers identified that 1,020 unique antibiotic combinations that were utilized, with vancomycin and gentamicin (19.2%) and ampicillin and gentamicin (12.0%) administered most frequently. However, 75% of these 1,020 regimens were given to fewer than 10 infants each, demonstrating a lack of consistency in antibiotic selection and utilization. Over the course of the 15-year study period, the use of nafcillin or oxacillin-containing regimens increased from 7.3% to 17.8% and the use of piperacillin/tazobactam or cefepime-containing regimens increased from 4.5% to 24.3%, while the use of vancomycin-containing regimens decreased from 58.8% to 36.0%.
“Our study emphasizes the critical need for guidance to support antibiotic selection,” said lead study author Sarah Coggins, MD MSCE, an attending neonatologist in the Division of Neonatology at CHOP and CHOP Newborn Care at Pennsylvania Hospital, and a core faculty member in Clinical Futures, a CHOP Research Institute Center of Emphasis. “This would increase efficiency in rational drug selection, while minimizing unnecessary exposures to broader-spectrum agents.”
This study was supported by the Agency for Healthcare Research and Quality grant K08 HS027468 and access to the Premier Healthcare Database from Children’s Hospital of Philadelphia (CHOP) during the conduct of the study.
Coggins et al, “Late Antibiotic Use Among Preterm Infants Admitted
to the Neonatal Intensive Care Unit.” Pediatrics. Online October 16, 2025. DOI: 10.1542/peds.2025-071372.
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While preterm infants are frequently exposed to antibiotics after they are three days old due to suspected late-onset infections, there is no consensus surrounding which antibiotics should be prescribed. In a new study, researchers at Children’s Hospital of Philadelphia (CHOP) found a wide range of antibiotics prescribed at 699 hospitals across the country, underscoring the need for more streamlined guidance to optimize treatments for vulnerable patients while also practicing responsible antibiotic use.
The findings were published today in the journal Pediatrics.
Preterm infants are at high risk for infection due to a variety of factors, leading to frequent antibiotic administration in neonatal intensive care units (NICUs). Neonatal late-onset sepsis (LOS) is defined as bacterial or fungal infections occurring beyond 72 hours after birth. LOS affects about 12% of very-low birth weight infants born at or prior to 30 weeks’ gestation and is associated with substantial morbidity and mortality. However, no consensus recommendations to guide antibiotic selection are available, partly due to low-quality evidence and variation among NICU centers.
To address this gap, researchers conducted a retrospective study using the Premier Healthcare Database, a comprehensive electronic healthcare data repository. In total, the study examined data from 420,687 infants who were born at or before 34 weeks’ gestation and admitted to one of 699 NICUs between 2009 and 2023. 65,398 infants (15.5%) were administered late antibiotics and were studied in more detail.
The study found that antibiotic exposure occurred most frequently among extremely preterm infants, with 75% of infants born at 22 to 24 weeks of gestation administered late antibiotics. Researchers identified that 1,020 unique antibiotic combinations that were utilized, with vancomycin and gentamicin (19.2%) and ampicillin and gentamicin (12.0%) administered most frequently. However, 75% of these 1,020 regimens were given to fewer than 10 infants each, demonstrating a lack of consistency in antibiotic selection and utilization. Over the course of the 15-year study period, the use of nafcillin or oxacillin-containing regimens increased from 7.3% to 17.8% and the use of piperacillin/tazobactam or cefepime-containing regimens increased from 4.5% to 24.3%, while the use of vancomycin-containing regimens decreased from 58.8% to 36.0%.
“Our study emphasizes the critical need for guidance to support antibiotic selection,” said lead study author Sarah Coggins, MD MSCE, an attending neonatologist in the Division of Neonatology at CHOP and CHOP Newborn Care at Pennsylvania Hospital, and a core faculty member in Clinical Futures, a CHOP Research Institute Center of Emphasis. “This would increase efficiency in rational drug selection, while minimizing unnecessary exposures to broader-spectrum agents.”
This study was supported by the Agency for Healthcare Research and Quality grant K08 HS027468 and access to the Premier Healthcare Database from Children’s Hospital of Philadelphia (CHOP) during the conduct of the study.
Coggins et al, “Late Antibiotic Use Among Preterm Infants Admitted
to the Neonatal Intensive Care Unit.” Pediatrics. Online October 16, 2025. DOI: 10.1542/peds.2025-071372.
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