Antibiotics | Antibiotics Use in Newborns from an Ethical Perspective

This article systematically analyzes the current status of antibiotic use in very preterm infants, explores ethical dilemmas from the perspectives of parents, medical teams, and regulatory bodies, highlights the importance of antimicrobial stewardship programs (ASPs), and proposes strategies to optimize antibiotic management while balancing neonatal health benefits and antimicrobial resistance (AMR) risks.

 

Literature Overview
This study, titled 'Neonatology: First Exposure To Antibiotics from the Ethical Perspective of Parents, Physicians, and Regulators', published in the journal Antibiotics, reviews the complex ethical relationships between antibiotic exposure and very preterm infants (VPIs). The research emphasizes that antibiotic use in neonatal intensive care units (NICUs) extends beyond clinical treatment to encompass family emotional dynamics, allocation of medical decision-making authority, and global antimicrobial resistance (AMR) challenges. It thoroughly examines diagnostic tools, duration standards for antibiotic administration, and stakeholder position differences in decision-making, offering multidisciplinary insights for clinical practice and policy development.

Background Knowledge
Due to underdeveloped immune systems, very preterm infants face high infection risks, necessitating widespread antibiotic use in NICUs. However, prolonged antibiotic exposure correlates with increased AMR, microbiome dysbiosis, and developmental complications. While substantial evidence supports biomarker-guided antibiotic protocols (e.g., PCT, CRP), overtreatment and empirical prescribing remain prevalent. Parents often lack critical information for informed decision-making, while regulators confront rising AMR rates and delayed pharmaceutical innovation. This paper introduces an ethical framework to reconcile these stakeholder interests and proposes actionable pathways for optimizing antibiotic use.

 

 

Research Methods and Experiments
The study employs a systematic literature review combined with ethical analysis to evaluate antibiotic use patterns in very preterm infants. It assesses the role of diagnostic tools (CRP, PCT, IL-6, blood cultures) in guiding initiation, continuation, and discontinuation of antibiotic therapy. Ethical conflicts and potential collaborations among stakeholders (parents, physicians, regulators) are analyzed through clinical studies, systematic reviews, and epidemiological data.

Key Conclusions and Perspectives

• Antibiotic use is ubiquitous in very preterm infants, with empirical treatment dominating clinical practice. Even in cases of negative blood cultures, therapy often continues for 5–7 days.
• Antibiotic overuse directly correlates with elevated risks of nosocomial infections, microbiome disruption, and AMR emergence. Long-term exposure may increase susceptibility to asthma, obesity, and neurodevelopmental disorders.
• Medical teams hold primary decision-making authority in NICUs but operate under dual pressures: diagnostic uncertainty and institutional infection control policies.
• Parents demonstrate limited influence over treatment decisions despite heightened concerns about drug side effects and lifelong health impacts, emphasizing the need for transparent communication.
• Regulatory antimicrobial stewardship programs (ASPs) show limited efficacy in NICUs due to their complex clinical environment. Localized, multidisciplinary approaches are urgently required.
• Pharmaceutical industry engagement in neonatal drug development remains insufficient due to lack of formal approval pathways, necessitating expanded real-world evidence and systematic research.

Research Significance and Prospects
The study identifies ethical tensions in neonatal antibiotic prescribing and underscores the necessity for collaborative decision-making frameworks. Future priorities include establishing standardized communication protocols with families, developing NICU-specific ASP guidelines, implementing risk-stratified treatment strategies, and creating multinational observational networks to address ethical and methodological limitations in preterm infant clinical trials.

 

 

Conclusion
Very preterm infants represent a high-risk population for antibiotic exposure, requiring intricate ethical balancing in clinical decisions. This analysis reveals critical trade-offs between infection control and long-term developmental outcomes. While antibiotics significantly reduce mortality from early-onset sepsis, their misuse accelerates resistant pathogen spread and compromises neurodevelopmental trajectories. Recommendations include NICU-specific ASP customization, enhanced family-physician communication protocols, personalized treatment approaches based on risk assessment, and expanded utilization of real-world data and systematic observational studies to establish evidence-based neonatal care standards.

 

Iliya Mangarov, Simeon Iliev, Yulian Voynikov, Antoaneta Tsvetkova, and Irina Nikolova. Neonatology: First Exposure to Antibiotics from the Ethical Perspective of Parents, Physicians, and Regulators. Antibiotics.