Association Between Race and Early Antibiotic Use in Newborns Admitted to the Neonatal Intensive Care Unit

Introduction: Given the risk of early-onset sepsis, providers frequently prescribe empirical antibiotics to newborns admitted to the neonatal intensive care unit (NICU). Early and prolonged use of antibiotics in uninfected newborns is associated with many adverse effects and potentially life-threatening complications, particularly among those with very low birth weight (VLBW; \u3c1500g). Studies of neonatal antibiotic utilization often adjust for race, acknowledged as a social construct, but there is a paucity of data on whether there is an independent association between race and antibiotic use in this population. We hypothesized that Black newborns have higher antibiotic use after adjusting for confounding factors compared to other races. Design/Methods: Retrospective cohort study including newborns admitted to a NICU from 2012-2021 included in the Premier Health database, which captures inpatient encounters from academic and community hospitals across the US. Early antibiotic initiation was defined as any parenteral antibiotic administered within the first 3 days after birth. Prolonged antibiotic duration was defined as early antibiotic initiation that was continued for \u3e4 days. Race was categorized as non-Hispanic Black, non-Hispanic White, non-Hispanic Asian, Hispanic, and Other/unknown race or ethnicity. Standard descriptive and comparative statistics were performed. Multivariable logistic regression, stratified by birth weight ≥ and \u3c1500g, was used to determine the association between race (non-Hispanic Black vs non-Hispanic White, and non-Hispanic Black vs other races/ethnicities) and early/prolonged antibiotic use, adjusting for potential confounders including birthweight category, length of stay, hospital setting, geographic region, and teaching status, accounting for clustering by center. Results: A total of 865,893 newborns from 699 NICUs were included. Overall, 478,045 (55.2%) were male, 108,896 (12.6%) were Hispanic ethnicity, 5236 (0.6%) died, and median length of stay was 7 days (IQR 4,17). Demographics and clinical characteristics between the different race/ethnicity groups are shown in Table 1. In the unadjusted analysis comparing infants of non-Hispanic Black race to non-Hispanic White and other race/ethnicity, stratified by birth weight ≥ and \u3c1500g, there were differences in antibiotic initiation and prolonged duration identified (Table 2). After adjusting for available potential confounders and accounting for clustering by center, non-Hispanic Black infants ≥ 1500g had higher odds of antibiotic initiation (aOR 1.09, 95%CI 1.02,1.2; p=0.02) compared to non-Hispanic White infants (Table 2). Non-Hispanic Black infants \u3c1500g had higher odds of antibiotic initiation (aOR 1.4, 95%CI 1.3,1.6; p\u3c0.001) and prolonged antibiotic duration (aOR 1.2, 95%CI 1.02,1.4; p=0.03) compared to non-Hispanic White infants, and higher odds of antibiotic initiation (aOR 1.3, 95%CI 1.1,1.5; p\u3c0.001) compared to other races/ethnicities (Table 2). Discussion: Newborns of non-Hispanic Black race/ethnicity compared to non-Hispanic White had increased odds of antibiotic initiation when stratified by birth weight. Non-Hispanic black infants with birth weight \u3c1500g also had increased odds of antibiotic initiation when compared to other races/ethnicities. Though this study is limited due to low granularity of patient level data and associations possibly being confounded by other factors, its significance still warrants further study. Future studies must explore if other factors, including maternal factors influenced by structural racism, are being considered when prescribing early antibiotics in the NICU

Association of postnatal age with neonatal hospital-onset bacteremia in a multicenter, retrospective cohort

Background: Prevention of hospital-onset bacteremia (HOB) in all settings is a healthcare priority. The CDC is developing a neonatal-specific HOB quality metric, but the epidemiology of neonatal HOB is poorly understood. Our objective was to validate a prior single-center finding that HOB risk varies by birthweight and postnatal age in a multicenter cohort. Methods: We performed a multicenter, retrospective cohort study of neonates admitted to 4 neonatal intensive care units (NICUs) for ≥4 days between July 1, 2016, and July 1, 2021. HOB was defined as a positive blood culture for bacteria or fungi on day ≥4 of admission. The first HOB event in the hospitalization was counted per neonate. Repeat HOB events during a neonate’s admission were excluded. Poisson regression models with robust variance estimates were used to estimate the incidence rate (IR) of HOB, expressed as HOB events per 1,000 patient days and IR ratios (IRRs), within strata defined by CDC birthweight categories and 4-week postnatal age intervals, adjusting for central venous catheter (CVC) presence at time of HOB and study site. Results: The analysis included 9,267 neonates, contributing 191,295 patient days and 470 HOB events, with an unadjusted IR of 2.46 per 1,000 patient days (Table 1). Of 477 infants born ≤750 g, 153 (30.1%) had a HOB with an IR of 13.3 (95% CI, 10.5–16.0) events per 1,000 patient days in the first 4 weeks after birth (Fig. 1). After adjusting for CVC presence and study site, infants ≤750 g had a higher HOB rate in the first 4 weeks of life (IRR, 7.45; 95% CI, 3.81–14.56) compared to infants ≥2,500 g. After 8 weeks of life, there was no difference in HOB rate in the 2 groups (IRR, 0.8, 95% CI, 0.3–2.7). Conclusions: Neonates born ≤750 g were at highest risk for HOB within the first 4 weeks after birth; however, risk for HOB was not consistent over time. Postnatal age should be considered in a neonatal HOB quality metric

Time to positivity of blood cultures in neonatal late-onset bacteraemia.

OBJECTIVE: To determine the time to positivity (TTP) of blood cultures among infants with late-onset bacteraemia and predictors of TTP >36 hours. DESIGN: Retrospective cohort study. SETTING: 16 birth centres in two healthcare systems. PATIENTS: Infants with positive blood cultures obtained >72 hours after birth. OUTCOME: The main outcome was TTP, defined as the time interval from specimen collection to when a neonatal provider was notified of culture growth. TTP analysis was restricted to the first positive culture per infant. Patient-specific and infection-specific factors were analysed for association with TTP >36 hours. RESULTS: Of 10 235 blood cultures obtained from 3808 infants, 1082 (10.6%) were positive. Restricting to bacterial pathogens and the first positive culture, the median TTP (25th-75th percentile) for 428 cultures was 23.5 hours (18.4-29.9); 364 (85.0%) resulted in 36 hours. Excluding coagulase-negative staphylococci (CoNS), 275 of 294 (93.5%) cultures were flagged positive by 36 hours. In a multivariable model, CoNS isolation and antibiotic pretreatment were significantly associated with increased odds of TTP >36 hours. Projecting a 36-hour empiric duration at one site and assuming that all negative evaluations were associated with an empiric course of antibiotics, we estimated that 1164 doses of antibiotics would be avoided in 629 infants over 10 years, while delaying a subsequent antibiotic dose in 13 infants with bacteraemia. CONCLUSIONS: Empiric antibiotic administration in late-onset infection evaluations (not targeting CoNS) can be stopped at 36 hours. Longer durations (48 hours) should be considered when there is pretreatment or antibiotic therapy is directed at CoNS

Brainhack: Developing a culture of open, inclusive, community-driven neuroscience

Brainhack is an innovative meeting format that promotes scientific collaboration and education in an open, inclusive environment. This NeuroView describes the myriad benefits for participants and the research community and how Brainhacks complement conventional formats to augment scientific progress