Antimicrobial Stewardship for Newborns in the Neonatal Intensive Care Unit

Overuse of antibiotics causing antibiotic resistance, an increase in Clostridium difficile infections, and increased adverse drug reactions is a growing problem. To combat this growing threat, the Centers for Disease Control started a program to improve the appropriate use of antimicrobials that focuses on antimicrobial stewardship. In the neonatal intensive care unit (NICU) medically fragile infants are commonly exposed to antibiotics resulting in a growing interest in applying antimicrobial stewardship principles in this patient population. The lack of treatment guidelines and the relatively narrow spectrum of individual antibiotics used to make the NICU a unique environment requiring a specialized approach to antimicrobial stewardship. This article examines the current antibiotic treatment data for common NICU illnesses including early and late-onset sepsis, pneumonia, and necrotizing enterocolitis, then reviews current recommendations for antimicrobial stewardship.