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Challenges and opportunities for antibiotic stewardship among preterm infants
  1. Sagori Mukhopadhyay1,2,
  2. Shaon Sengupta1,2,
  3. Karen M Puopolo1,2
  1. 1 Division of Neonatology, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
  2. 2 Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
  1. Correspondence to Dr Sagori Mukhopadhyay, The Children’s Hospital of Philadelphia Newborn Care at Pennsylvania Hospital, Philadelphia, PA 19107, USA; sagori.mukhopadhyay{at}


Antibiotic stewardship programmes aim to optimise antimicrobial use to prevent the emergence of resistance species and protect patients from the side effects of unnecessary medication. The high incidence of systemic infection and associated mortality from these infections leads neonatal providers to frequently initiate antibiotic therapy and make empiric antibiotic courses one of the main contributors of antibiotic use in the neonatal units. Yet, premature infants are also at risk for acute life-threatening complications associated with antibiotic use such as necrotising enterocolitis and for long-term morbidities such as asthma. In this review, we discuss specific aspects of antibiotic use in the very low birthweight preterm infants, with a focus on empiric use, that provide opportunities for stewardship practice. We discuss strategies to risk-stratify antibiotic initiation for the risk of early-onset sepsis, optimise empiric therapy duration and antibiotic choice in late-onset sepsis, and standardise decisions for stopping empiric therapy. Lastly, review the evolving role of biomarkers in antibiotic stewardship.

  • antibiotic stewardship
  • very low birth weight
  • premature

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  • Contributors SM conceptualised and drafted the initial manuscript, conducted literature review and approved the final manuscript as submitted. SS helped draft the initial manuscript, reviewed and revised the manuscript, and approved the final manuscript as submitted. KMP contributed to literature review, reviewed and revised the manuscript, and approved the final manuscript as submitted.

  • Funding This study was funded by Eunice Kennedy Shriver National Institute of Child Health and Human Development (grant number 1K23HD088753-01A1), and the National Heart, Lung, and Blood Institute (grant number 1K08HL132053-01A1).

  • Competing interests None declared.

  • Patient consent Not required.

  • Provenance and peer review Commissioned; externally peer reviewed.