Why Do We Need NICU Stewardship?

Segment Description: Pablo J. Sánchez, MD, professor of pediatrics, Divisions of Neonatology & Pediatric Infectious Diseases at Nationwide Children’s Hospital and the Ohio State University, discusses the need for neonatal intensive care (NICU) stewardship with Debra Goff, PharmD, and Pavel Prusakov, PharmD.

Interview transcript (modified slightly for readability):

Okay, so why do we need NICU stewardship? So NICU stewardship is extremely important because these babies in the neonatal ICU are very high risk and antibiotic use in babies and individuals, anybody will result in dysbiosis of their intestinal and bacterial microbiome. And it has been shown, and we've shown it and others as well, that this resultant dysbiosis has been associated with necrotizing enterocolitis, which is a major disease, inflammatory condition of the premature intestinal bowel that results in high morbidity and even mortality.

In addition, the overuse of antibiotics has also been associated with other conditions such as retinopathy prematurity, as well as late-onset sepsis, and even with mortality, and also been associated with Bronco pulmonary dysplasia—all of the conditions that we're concerned about that are sequela of this change in the bacterial microbiome of these high-risk babies.

In addition, it's also been associated with worse neurodevelopmental outcomes at 2 to 3 years of age. So, it is extremely important. What we have shown is that each additional day of antibiotic use has been associated with a significant increase in the composite of late-onset sepsis, necrotizing enterocolitis, and death.

So it's no longer saying that we're only going to give them 48 [hours], 72 [hours], 5 days, or 10 days of antibiotics, we have to consider each day as potentially causing adverse outcomes on these babies.

We have looked at antibiotic use in the neonatal ICU in Dallas, and we're looking at it as well, in the neonatal ICU with a Nationwide Children's. And we have been able to successfully reduce and safely reduced antibiotic use to rule out sepsis at birth to 24 hours, pneumonia treatment for 5 days, culture negative sepsis for 5 days. And we've published that in The Lancet Infectious Diseases and we're working to implement that in South Africa.

This is part 1 of a 3 part interview.