A Delicate Balance

                      I recently read an article in Science about antibiotics in prematurely born babies. As we learn more and more about the human body we come to realize that things we have done in the past are not always the best for us going forward. One of the hot new topics in science is the microbiome, or the trillions of cells that live in our body. The gut biome has been described as an organ of its own, weighing as much as the liver and having more neurotransmitters than the brain. This article looks at the data on the effects of blanket antibiotics given to premature babies and how it affects them in life. One thing that the researchers discovered is just how widespread the antibiotic have become. One example was a premature baby at the Duke NICU that had been prescribed antibiotics without testing for infection or any signs of infection. The researchers realized that this is a very common practice. There are nearly half a million babies born prematurely a year and a good majority are given antibiotics without signs of infection or testing for infection. This has raised the question of whether this practice is doing more harm than good. They found that a premature baby’s gut microbiome will be severely affected by antibiotics. Many doctors are to starting to realize that blanket antibiotics are not the answer in other specialties, but the neonatal units are not adapting quickly to this view. Three of the top four drugs prescribed in the NICU are antibiotics. What researchers found is that early use of antibiotics to prevent thing like sepsis has been reduced, leading to today's high premature birth survival rate. On the other hand, we are seeing an increase in late-onset sepsis and necrotizing enterocolitis as the babies mature. Another study in Pediatrics showed that for each additional day that a premature baby was on antibiotics, it was at an increased rate of necrotizing enterocolitis and death. Stool samples revealed that the biodiversity of premature babies who were long term antibiotic users showed a decimation of diversity in the microbiome compared to those that were just on them for a few days. The researcher was not able to get a proper control as all the premature babies had been exposed to antibiotics. The researchers have begun trials after getting long-awaited approval from institutional review boards who were slow to accept the idea. The biggest roadblock they are currently finding is the physicians stuck in their old ways that even when assigned the control group will revert to giving them antibiotics at the sign of a sniffle. It is good that there are researchers that are questioning this long-held practice and are continuing to attempt and make our world a safer place.



Zane Ruehrwein (3)

http://science.sciencemag.org/content/360/6384/18.full.