When more can lose more - Comments to the long-term use of prophylactic antibiotics for very low birth weight infant resulting in the adverse outcomes

Sep 29, 2026

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Editorial commentary argues that while encouraging pregnancy and improving perinatal care are crucial, premature preterm birth remains a major driver of high maternal and infant morbidity and mortality. It highlights that very low–birth weight infants are highly vulnerable to microorganism-related injuries, and discusses evidence on increased early-life antibiotic exposure and its associations with necrotizing enterocolitis and bronchopulmonary dysplasia, emphasizing unresolved uncertainties and the need to clarify antibiotic indications and timing in future management.

LanguageEnglish

CategoryHealthcare

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Pages2

Reading Time5 min

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Editorial: When more can lose more

Context and public health challenge of PPB

Vulnerability of VLBW infants and infectious etiologies

Discussion of reported associations with adverse outcomes

J Chin MedAssoc EDITORIAL When more can lose more: Comments to the long-term use of prophylactic antibiotics for very low birth weight infant resulting in the adverse outcomes Wen-Ling Leea,b,c, Fa-Kung Leed,e, Peng-Hui Wangb,e,f,g,* aDepartment of Medicine, Cheng-Hsin General Hospital, Taipei, Taiwan, ROC; bInstitute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC; cDepartment of Nursing, Oriental Institute of Technology, New Taipei City, Taiwan, ROC; dDepartment of Obstetrics and Gynecology, Cathay General Hospital, Taipei, Taiwan, ROC; eFemale Cancer Foundation, Taipei, Taiwan, ROC; fDepartment of Obstetrics and Gynecology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; gDepartment of Medical Research, China Medical University Hospital, Taichung, Taiwan, ROC The population of size in Taiwan has been continuously decreased in the recent years, resulting in an absolutely negative balance of population in 2021.1 Although many causes contributing to the decreased population size have been reported in Taiwan, one definite cause is the result of death rate exceeding birth rate.1 Therefore, the policy to encourage couples to get pregnancy and subsequently offering a better care for maternal-fetal wellbeing before, during, and after pregnancy is of paramount importance.2–6 Many efforts have been conducted, but the morbidity and mortality of women during pregnancy and perinatal morbidity and mortality are still high in Taiwan.1 Among these, premature preterm birth (PPB) has been one of the critical causes resulting in the high morbidity and mortality of both mothers and infants. Additionally, PPB has been increased in recent years dramatically, and it becomes a biggest challenge not only for obstetricians but also pediatricians.7–9 An early identification of risk factors associated with PPB and an offering the prompt and effective treatment may decrease the PPB-related morbidity and mortality.10 However, none of them can totally avoid the incidence and prevalence of PPB and the outcomes of very low–birth weight (VLBW) newborns are still disappointing based on their immature organogenesis and physiological malfunction, even though advances of current medical care have improved the survival of these infants.11 These VLBW infants are vulnerable to insults-related injuries either from internal or external sources.11 Attacks by microorganisms may be one of 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 addresses: phwang@vghtpe.gov.tw](ROC. E-mail addresses: 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: 1107-1108. Received October 2, 2022; accepted October 4, 2022. doi: 10. 1097/JCMA.0000000000000826. 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/)) most common etiologies compromising the wellbeing of these PPB infants, contributing to a main cause of infant morbidity and mortality in modern medicine. This catastrophic event is particularly apparent in the VLBW preterm infant population.12 A recent publication from the Journal of the Chinese Medical Association entitled “Increased antibiotics exposure in early life is associated with adverse outcomes in very low birth weight infants” has focused on the worse outc

FAQs

Why does the editorial emphasize the problem of premature preterm birth (PPB) in Taiwan?

It notes that PPB has increased dramatically and remains a critical cause of high morbidity and mortality for both mothers and infants, creating major challenges for obstetricians and pediatricians.

What adverse outcomes are linked to increased early-life antibiotic exposure in very low birth weight (VLBW) infants?

The editorial refers to findings associating greater antibiotic exposure with higher risks of necrotizing enterocolitis (NEC) and bronchopulmonary dysplasia (BPD), with longer exposure further increasing those risks.

What uncertainty does the editorial say needs further discussion before shaping future management?

It argues that the indications and needs for using antibiotics in VLBW infants should be clarified and analyzed, since the referenced study focused on early-onset sepsis and may not fully address antibiotic rationale.

Sep 29, 2026

Uploaded by Rhys