Reply to “Is antibiotic exposure associated with an increased risk of developing necrotizing enterocolitis and bronchopulmonary dysplasia in very low birth weight infants?”

Sep 29, 2026

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Letter to the editor responding to comments and questions about a prior study published in the Journal of the Chinese Medical Association in June 2022. The authors clarify the antibiotic-exposure comparison approach using median days of exposure (8 days) to form two similarly sized groups, and address the rationale for selecting adjusting variables in relation to NEC and BPD. They also explain exclusions of gestational age, birth weight, and fifth-minute Apgar score due to inclusion in SNAPPE-II, and close by reiterating the adequacy of their responses.

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CategoryHealthcare

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Letter to the Editor

Response to the first query

Response to the second query

References

J Chin MedAssoc LETTER TO THE EDITOR Reply to: “Is antibiotic exposure associated with an increased risk of developing necrotizing enterocolitis and bronchopulmonary dysplasia in very low birth weight infants?” Wen-Yin Chen, Miao-Chiu Hung Division of Infectious Diseases, Department of Pediatrics, Taipei Veterans General Hospital and National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC DEAR EDITOR, We thank Dr. Peng-Hui Wang for the valuable comments1 and questions on our study named “Increased antibiotic exposure in early life is associated with adverse outcomes in very low birth weight infants” published in Journal of the Chinese Medical Association in June 2022.2 The author comments are discussed below. For the first query, the exposure of antibiotics was the focus of our study, while the use of probiotics was an additional finding. The main purpose of this part of analysis was to see whether there were demographical differences between infants receiving longer duration of antibiotics and those receiving shorter duration of antibiotics treatment. However, there was no standard definition of “short antibiotic treatment” or “prolonged antibiotic treatment.”Therefore, they were intended to be divided into two groups equal in case numbers (i.e., according to the median days of antibiotic exposure, which was eight) . There were 14 infants received 8 days of antibiotics, they were grouped into the “shorter duration of antibiotic use” group so that the two groups could be more equal in case numbers. Regarding the second query, the selection of the adjusting variables was based on the previous studies that showed significantly to be associated with NEC or BPD. Gestational age, birth weight, and Apgar score at the fifth minute were not included in the models because they were included in the SNAPPE-II, which might cause collinearity in the analyses. We hope these explanations will suffice the readers’ and the authors’ expectations. Thanks for your kind comments again. REFERENCES 1. Kuo SC, Chen SF, Wang PH. Is antibiotic exposure associated with an increased risk of developing necrotizing enterocolitis and bronchopulmonary dysplasia in very low birth weight infants? J Chin Med Assoc 2022;85:1160-1 . 2. Chen WY, Lo YC, Huang PH, ChenYX, Tsao PC, Lee YS, et al. Increased antibiotic exposure in early life is associated with adverse outcomes in very low birth weight infants. J Chin Med Assoc 2022;85:939–43 . *Address cerrespondence. *Dr. Miao-Chiu Hung, Division of Infectious Diseases, Department of Pediatrics, Taipei Veterans General Hospital, 201, Section 2, Shi-Pai Road, Taipei 112 Taiwan, [ROC. E-mail address:mchung@vghtpe.gov.tw](ROC. E-mail address:mchung@vghtpe.gov.tw)[ ](ROC. E-mail address:mchung@vghtpe.gov.tw)(M.-C. Hung) Conflicts of interest: The 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: 1162. Received October 4, 2022; accepted October 5, 2022. doi: 10. 1097/JCMA.0000000000000828. 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/)) 1162 [www.ejcma.org](www.ejcma.org)

FAQs

What was the focus of the authors’ study in the first part of the response?

The first part focused on antibiotic exposure, with probiotic use treated as an additional finding. The authors examined whether demographic differences existed between infants receiving longer versus shorter antibiotic durations.

How were the infants divided into groups for the antibiotic-duration analysis?

The authors acknowledged there was no standard definition for “short” versus “prolonged” treatment, so they divided infants into two groups with equal case numbers using the median antibiotic exposure duration of eight days.

Why were gestational age, birth weight, and fifth-minute Apgar score excluded from the models?

They were excluded because they were already included in SNAPPE-II, which the authors noted could introduce collinearity in the analyses.

Sep 29, 2026

Uploaded by Connor