The incidence of the neonatal abstinence syndrome, a drug-withdrawal syndrome that most commonly occurs after in utero exposure to opioids, is known to have increased during the past decade. However, recent trends in the incidence of the syndrome and changes in demographic characteristics and hospital treatment of these infants have not been well characterized.

In extremely low-birth-weight (ELBW) infants, chronic lung disease (CLD) has been associated with cardiopulmonary morbidity, adverse neurodevelopmental outcome, and mortality.¹ Multiple strategies have been investigated to reduce the risk of death or CLD.^2-6 In particular, Tyson and colleagues² and Ambalavanan and colleagues⁷ demonstrated that prophylactic vitamin A supplementation modestly and safely reduced the rates of death or CLD in ELBW infants with no adverse effects at the 18- to 22-month follow-up. The use of vitamin A has increased in the past decade,⁸ although vitamin A use has remained variable because of the perceived unfavorable risk to benefit ratio, among other reasons detailed by Kaplan et al.⁹ The national supply of the injectable form of vitamin A became scarce in late 2010 and continues to be commercially unavailable.¹⁰ Correspondingly, the anticipated reduction in vitamin A use and the related effect on the prevalence of death or CLD remains uncertain.

Objective To evaluate if an antibiotic automatic stop order (ASO) changed early antibiotic exposure (use in the first 7 days of life) or clinical outcomes in very low birth weight (VLBW) infants. Study Design We compared birth characteristics, early antibiotic exposure, morbidity, and mortality data in VLBW infants (with birth weight <= 1500 g) born 2 years before (pre-ASO group, n = 313) to infants born in the 2 years after (post-ASO, n = 361) implementation of an ASO guideline. Early antibiotic exposure was quantified by days of therapy (DOT) and antibiotic use > 48 hours. Secondary outcomes included mortality, early mortality, early onset sepsis (EOS), and necrotizing enterocolitis. Results Birth characteristics were similar between the two groups. We observed reduced median antibiotic exposure (pre-ASO: 6.5 DOT vs. Post-ASO: 4 DOT; p < 0.001), and a lower percentage of infants with antibiotic use > 48 hours (63.4 vs. 41.3%; p < 0.001). There were no differences in mortality (12.1 vs 10.2%; p = 0.44), early mortality, or other reported morbidities. EOS accounted for less than 10% of early antibiotic use. Conclusion Early antibiotic exposure was reduced after the implementation of an ASO without changes in observed outcomes.