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Variability in antibiotic duration for necrotizing enterocolitis and outcomes in a large multicenter cohort



To evaluate variability in antibiotic duration for necrotizing enterocolitis (NEC) and associated clinical outcomes.

Study design

Five-hundred ninety-one infants with NEC (315 medical; 276 surgical) were included from 22 centers participating in Children’s Hospitals Neonatal Consortium (CHNC). Multivariable analyses were used to determine predictors of variability in time to full feeds (TFF) and length of stay (LOS).


Median (IQR) antibiotic duration was 12 (9, 17) days for medical and 17 (14, 21) days for surgical NEC. Wide variability in antibiotic use existed both within and among centers. Duration of antibiotic therapy was associated with longer TFF in both medical (OR 1.04, 95% CI [1.01, 1.05], p < 0.001) and surgical NEC (OR 1.02 [1, 1.03] p = 0.046); and with longer LOS in medical (OR 1.03 [1.02, 1.04], p < 0.001) and surgical NEC (OR 1.01 [1.01, 1.02], p = 0.002).


Antibiotic duration for both medical and surgical NEC remains variable within and among high level NICUs.

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Fig. 1: Variability in antibiotic duration among participating CHNC centers.
Fig. 2: Relationship between variation in antibiotic prescribing practices and antibiotic duration for treatment of NEC in participating CHNC centers.
Fig. 3: Kaplan–Meier (K–M) analyses.

Data availability

All data relevant to the study are included in the article. Requests for additional material can be made to IA at


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Jeanette Asselin, David Durand (ex officio), Francine Dykes (ex officio), Jacquelyn Evans, Karna Murthy (Chair), Michael Padula, Eugenia Pallotto, Theresa Grover, Beverly Brozanski, and Anthony Piazza, Kristina Reber and Billie Short are members of the Children’s Hospitals Neonatal Consortium, Inc. For more information, please contact: We are indebted to the following institutions that serve the infants and their families, and these institutions also have invested in and continue to participate in the Children’s Hospital’s Neonatal Database (CHND). The site sponsors/contributors for the CHND are also included: 1. Children’s Healthcare of Atlanta, Atlanta, GA (Francine Dykes, Anthony Piazza). 2. Children’s Healthcare of Atlanta at Scottish Rite (Gregory Sysyn). 3. Children’s Hospital of Alabama, Birmingham, AL (Carl Coghill, Allison Black). 4. Le Bonheur Children’s Hospital, Memphis, TN (Ramasubbareddy Dhanireddy). 5. Children’s Hospital Boston, Boston, MA (Anne Hansen, Tanzeema Houssain). 6. Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL (Karna Murthy, Gustave Falciglia). 7. Cincinnati Children’s Hospital, Cincinnati, OH (Beth Haberman, Breda Poindexter, Amy Nathan, Kristin Nelson, Paul Kingma, Stefanie Riddle, Stephanie Merhar). 8. Nationwide Children’s Hospital, Columbus, OH (Kristina Reber). 9. Children’s Medical Center, Dallas, TX (Rashmin Savani, Luc Brion, Noorjahan Ali). 10. Children’s Hospital Colorado, Aurora, CO (Theresa Grover). 11. Children’s Hospital of Michigan, Detroit, MI (Girija Natarajan). 12. Cook Children’s Health Care System, Fort Worth, TX (Jonathan Nedrelow, Annie Chi, Yvette Johnson). 13. Texas Children’s Hospital, Houston, TX (Gautham Suresh). 14. Riley Children’s Hospital, Indianapolis, IN (William Engle, Lora Simpson, Gregory Sokol). 15. Children’s Mercy Hospitals & Clinics, Kansas City, MO (Eugenia Pallotto). 16. Arkansas Children’s Hospital, Little Rock, AR (Robert Lyle, Becky Rogers). 17. Children’s Hospital Los Angeles, Los Angeles, CA (Steven Chin, Rachel Chapman). 18. American Family Children’s Hospital, Madison, WI (Jamie Limjoco, Lori Haack). 19. Children’s Hospital & Research Center Oakland, Oakland, CA (David Durand, Jeanette Asselin, Art D’Harlingue, Priscilla Joe). 20. The Children’s Hospital of Philadelphia, Philadelphia, PA (Jacquelyn Evans, Michael Padula, David Munson). 21. Children’s Hospital of Pittsburgh of UPMC, Pittsburgh, PA (Toby Yanowitz). 22. St. Louis Children’s Hospital, St Louis, MO (Tasmin Najaf, Rakesh Rao). 23. All Children’s Hospital, St. Petersburg, FL (Victor McKay). 24. Rady Children’s Hospital, San Diego, CA (Mark Speziale, Brian Lane, Laural Moyer). 25. Children’s National Medical Center, Washington, DC (Billie Short). 26. AI DuPont Hospital for Children, Wilmington, DE (Kevin Sullivan). 27. Primary Children’s Medical Center, Salt Lake City, UT (Con Yee Ling, Shrena Patel). 28. Children’s Hospital of Wisconsin, Milwaukee, WI (Michael Uhing, Ankur Datta). 29. Children’s Hospital of Omaha (Lynne Willett, Nicole Birge). 30. Florida Hospital for Children (Rajan Wadhawan). 31. Seattle Children’s Hospital, Seattle, WA (Elizabeth Jacobsen-Misbe, Robert DiGeronimo, Zeenia Billimoria). 32. Hospital for Sick Children, Toronto, ON (Kyong-Soon Lee).

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Authors and Affiliations




All authors contributed intellectually to the conception of the study and provided critical inputs during the CHNC NEC work group meetings. IZ conducted data analysis, IA and TY drafted the initial manuscript, and all authors helped revised the manuscript as well as reviewed the final version.

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Correspondence to Irfan Ahmad.

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The authors declare no competing interests.

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Members of the Children’s Hospitals Neonatal Consortium NEC Focus Group are listed below Acknowledgements.

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Ahmad, I., Premkumar, M.H., Hair, A.B. et al. Variability in antibiotic duration for necrotizing enterocolitis and outcomes in a large multicenter cohort. J Perinatol 42, 1458–1464 (2022).

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