To systematically evaluate the association between early postnatal antibiotic exposure and bronchopulmonary dysplasia (BPD) as well as other adverse outcomes in very preterm infants, providing evidence for optimizing antibiotic stewardship in neonatal care.
Approach:
Data Sources: Systematic search in PubMed, Embase, Wiley Online Library, and the Cochrane Library from inception to March 2026.
Key Findings:
Early postnatal antibiotic exposure was associated with an increased risk of BPD (OR = 1.44, 95% CI: 1.12–1.85).
Increased risks of NEC (OR = 1.18, 95% CI: 1.09–1.28) and mortality (OR = 1.19, 95% CI: 1.05–1.35) were also observed.
No statistically significant association was found for late-onset sepsis (OR = 0.98, 95% CI: 0.71–1.34).
Interpretation:
Early postnatal antibiotic exposure is linked to an increased risk of BPD and several adverse outcomes in very preterm infants.
Limitations:
Publication bias was detected for BPD and mortality outcomes, which may affect the reliability of these findings.
The mortality result requires cautious interpretation after trim-and-fill correction.
Conclusion:
Early postnatal antibiotic exposure is associated with an increased risk of BPD and several adverse outcomes in very preterm infants.
