Is antibiotic exposure associated with an increased risk of developing necrotizing enterocolitis and bronchopulmonary dysplasia in very low birth weight infants? - Letter to the Editor

Sep 29, 2026

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Letter to the editor responding to a prior Journal of the Chinese Medical Association study on very low birth weight infants. The authors appreciate the contribution but question study design choices, especially antibiotic exposure grouping and the evaluation method for probiotic use. They note that adjusted odds ratios suggest higher risks of necrotizing enterocolitis and bronchopulmonary dysplasia with longer antibiotic exposure, yet they ask why specific covariates were selected for adjustment and why gestational age and birth weight were omitted. The letter urges clarification and a response.

LanguageEnglish

CategoryResearch & Report

FormatPDF

Pages2

Reading Time5 min

AccessFree to download

Letter to the Editor

Background and findings referenced

Questions on antibiotic exposure grouping and probiotic evaluation

Concerns about covariate selection for adjustment

Context and request for author response

J Chin MedAssoc LETTER TO THE EDITOR Is antibiotic exposure associated with an increased risk of developing necrotizing enterocolitis and bronchopulmonary dysplasia in very low birth weight infants? Shu-Chen Kuoa, Shu-Fen Chena,b, Peng-Hui Wangc,d,e,f,* aDepartment of Nursing, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; bGraduate Institute of Life Sciences, National Defense Medical Center, Taipei, Taiwan, ROC; cDepartment of Obstetrics and Gynecology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; dInstitute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC; eFemale Cancer Foundation, Taipei, Taiwan, ROC; fDepartment of Medical Research, China Medical University Hospital, Taichung, Taiwan, ROC DEAR EDITOR, We have read the article entitled “Increased antibiotics exposure in early life is associated with adverse outcomes in very low birth weight infants.” published in the September issue of the Journal of the Chinese Medical Association with interest.1 Chen et al1 attempted to explore whether increased antibiotics exposure with the routine use of probiotics was associated with necrotizing enterocolitis (NEC) or bronchopulmonary dysplasia (BPD) . The authors found that there was no significant difference of occurrence of NEC or BPD in very low birth weight (VLBW) infants, regardless probiotics were routinely used or not.1 Additionally, they identified that increased antibiotic exposure of VLBW infants was associated with increased risks of NEC and BPD with an adjusted odd ratio of 1.278 (95% confidence interval [CI], 1.025- 1.593) and 1.630 (95% CI, 1.233-2.156), respectively.1 We appreciated the authors’ excellent contribution to an improved care of these VLBW infants vulnerable to injuries due to prematurity,2,3 but there are some questions that need clarification. Based on the hypothesis the authors proposed, they attempted to explore the role of the duration of antibiotic exposure and probiotic use on the occurrence of NEC and BPD. We are wondering to know why the authors only separate the study subjects into two categories, 0 to 8 days of antibiotic exposure and 9 to 14 days of antibiotic exposure, since this separation did not answer their other aim to evaluate the effect of probiotic use on the development of NEC and BPD. If their strategy is correct, the * Address correspondence. Dr. Peng-Hui Wang, Department of Obstetricsand Gynecology, Taipei Veterans General Hospital, 201, Section 2, Shi-Pai Road, Taipei 112, Taiwan, [ROC. E-mail address: phwang@vghtpe.gov.tw](ROC. E-mail address: phwang@vghtpe.gov.tw); [pongpongwang@gmail.com](pongpongwang@gmail.com) (P.-H. Wang). Conflicts of interest: Dr. Peng-Hui Wang, an editorial board member at Journal of the Chinese Medical Association, had no role in the peer review process of or decision to publish this article. The other authors declare that they have no conflicts of interest related to the subject matter or materials discussed in this article. Journal of Chinese Medical Association. (2022) 85: 1160-1161. Received September 18, 2022; accepted September 21, 2022. doi: 10. 1097/JCMA.0000000000000821. Copyright © 2022, the Chinese Medical Association. This is an open access article under the CC BY-NC-ND license ([http://creativecommons.org/licenses/](http://creativecommons.org/licenses/)[ ](http://creativecommons.org/licenses/)[by-nc-nd/4.0/](by-nc-nd/4.0/)) “use of probiotics” and “no-use of probiotics” should be evaluated by another table. There are many possible factors associated with the development of NEC and BPD, including antenatal factors, such as gestational age, birth weight, and Apgar score at the fifth minute; and infant information to day 14, such as score for neonatal acute physiology with perinatal Extension-II, use of surfactant, presence of hemodynamically significant patent ductus arteriosus (PDA), days of mechanical ventilation, days of oxygen supplementation more than frac

FAQs

What is the main issue this letter addresses?

It addresses whether increased early-life antibiotic exposure is associated with higher risks of necrotizing enterocolitis and bronchopulmonary dysplasia in very low birth weight infants, and it questions aspects of how the prior study evaluated these relationships.

Why does the letter question the antibiotic exposure grouping used in the referenced study?

The letter asks why subjects were split into only 0–8 days versus 9–14 days, arguing that this split does not adequately support the study’s aim of evaluating the effect of probiotic use.

What additional factors does the letter suggest should have been adjusted for?

It suggests that gestational weeks and birth weight are conventional key factors reported as strongly independent risk factors for newborn outcomes and asks why they were not included in adjusting data for the targeted item.

Sep 29, 2026

Upload by Jacob