{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,9]],"date-time":"2026-06-09T22:09:13Z","timestamp":1781042953090,"version":"3.54.1"},"reference-count":47,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2019,10,24]],"date-time":"2019-10-24T00:00:00Z","timestamp":1571875200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100005036","name":"Universitetet i Bergen","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100005036","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Pediatr."],"abstract":"<jats:p><jats:bold>Background:<\/jats:bold> Worldwide, a large proportion of neonates are prescribed antibiotics without having infections leading to increased antimicrobial resistance, disturbance of the evolving microbiota, and increasing the risk of various chronical diseases. Comparing practice between different hospitals\/settings is important in order to optimize antibiotic stewardship.<\/jats:p><jats:p><jats:bold>Aim:<\/jats:bold> To investigate and compare the potential for improved antibiotic stewardship in neonates in two Norwegian hospitals with different academic culture, with emphasis on antibiotic exposure in unconfirmed infections, treatment length\/doses, CRP values and the use of broad-spectrum antibiotics (BSA). All types of infections were investigated, but the main focus was on early-onset sepsis (EOS).<\/jats:p><jats:p><jats:bold>Methods:<\/jats:bold> We conducted a prospective observational cohort study of antibiotic use in a Norwegian university hospital (UH) and a district hospital (DH), 2017. Unconfirmed infections were defined as culture negative infections that neither fulfilled the criteria for clinical infection (clinical symptoms, maximum CRP &amp;gt;30 mg\/L, and treatment for at least 5 days).<\/jats:p><jats:p><jats:bold>Results:<\/jats:bold> Ninety-five neonates at the DH and 89 neonates at the UH treated with systemic antibiotics were included in the study. In total, 685 prescriptions (daily doses) of antibiotics were given at the DH and 903 at the UH. Among term and premature infants (\u2265 28 weeks), 82% (75% at the UH and 86% at the DH, <jats:italic>p<\/jats:italic> = 0.172) of the treatments for suspected EOS were for unconfirmed infections, and average treatment length in unconfirmed infections was 3.1 days (both hospitals). Median dose for aminoglycoside was higher for term infants at the UH (5.96, 95% CI 5.02\u20136.89) compared to the DH (4.98, 95% CI 4.82\u20135.14; <jats:italic>p<\/jats:italic> &amp;lt; 0.001). At the UH, all prescriptions with aminoglycosides were gentamicin, while tobramycin accounted for 93% of all prescriptions with aminoglycosides at the DH.<\/jats:p><jats:p><jats:bold>Conclusion:<\/jats:bold> There is a potential for reduction in both antibiotic exposure and treatment length in these two neonatal units, and a systematic risk\/observational algorithm of sepsis should be considered in both hospitals. We revealed no major differences between the UH and DH, but doses and choice of aminoglycosides varied significantly.<\/jats:p>","DOI":"10.3389\/fped.2019.00440","type":"journal-article","created":{"date-parts":[[2019,10,24]],"date-time":"2019-10-24T04:23:26Z","timestamp":1571891006000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":5,"title":["Can We Optimize Antibiotic Use in Norwegian Neonates? A Prospective Comparison Between a University Hospital and a District Hospital"],"prefix":"10.3389","volume":"7","author":[{"given":"Christian Magnus","family":"Thaulow","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dag","family":"Berild","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hege Salvesen","family":"Blix","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anne Karin","family":"Brigtsen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tor \u00c5ge","family":"Myklebust","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Beate Horsberg","family":"Eriksen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2019,10,24]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"12","DOI":"10.1111\/j.1469-0691.2009.02725.x","article-title":"Antibiotic consumption and link to resistance","volume":"15","author":"Goossens","year":"2009","journal-title":"Clin Microbiol Infect."},{"key":"B2","doi-asserted-by":"publisher","first-page":"22","DOI":"10.1016\/j.nmni.2015.02.007","article-title":"The global threat of antimicrobial resistance: science for intervention","volume":"6","author":"Roca","year":"2015","journal-title":"N Microbes N Infect."},{"key":"B3","volume-title":"Usage of Antimicrobial Agents and Occurrence of Antimicrobial Resistance in Norway.","author":"NORM\/NORM-VET","year":"2018"},{"key":"B4","volume-title":"National Strategy against Antibiotic Resistance 2015\u20132020.","year":"2015"},{"key":"B5","doi-asserted-by":"publisher","first-page":"10410","DOI":"10.1038\/ncomms10410","article-title":"Intestinal microbiome is related to lifetime antibiotic use in Finnish pre-school children","volume":"7","author":"Korpela","year":"2016","journal-title":"Nat Commun."},{"key":"B6","doi-asserted-by":"publisher","first-page":"973","DOI":"10.1016\/S0140-6736(00)90015-1","article-title":"An antibiotic policy to prevent emergence of resistant bacilli","volume":"355","author":"de Man","year":"2000","journal-title":"Lancet."},{"key":"B7","doi-asserted-by":"publisher","first-page":"569","DOI":"10.1093\/jac\/dkx426","article-title":"Antibiotic therapy in neonates and impact on gut microbiota and antibiotic resistance development: a systematic review","volume":"3","author":"Fjalstad","year":"2017","journal-title":"J Antimicrob Chemother."},{"key":"B8","doi-asserted-by":"publisher","first-page":"1063","DOI":"10.1001\/jamapediatrics.2014.1539","article-title":"Association of antibiotics in infancy with early childhood obesity","volume":"168","author":"Bailey","year":"2014","journal-title":"JAMA Pediatr."},{"key":"B9","doi-asserted-by":"publisher","first-page":"326","DOI":"10.3109\/1040841X.2013.837863","article-title":"Early life events influence whole-of-life metabolic health via gut microflora and gut permeability","volume":"41","author":"Kerr","year":"2015","journal-title":"Crit Rev Microbiol."},{"key":"B10","doi-asserted-by":"publisher","first-page":"e180315","DOI":"10.1001\/jamapediatrics.2018.0315","article-title":"Association between use of acid-suppressive medications and antibiotics during infancy and allergic diseases in early childhood","author":"Mitre","year":"2018","journal-title":"JAMA Pediatr."},{"key":"B11","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1097\/INF.0000000000000906","article-title":"Early-onset sepsis and antibiotic exposure in term infants: a nationwide population-based study in Norway","volume":"35","author":"Fjalstad","year":"2016","journal-title":"Pediatr Infect Dis J."},{"key":"B12","doi-asserted-by":"publisher","first-page":"F141","DOI":"10.1136\/adc.2007.120709","article-title":"Improving antibiotic prescribing in neonatal units: time to act","volume":"97","author":"Russell","year":"2012","journal-title":"Arch Dis Child Fetal Neonatal Ed."},{"key":"B13","doi-asserted-by":"publisher","first-page":"e20170044","DOI":"10.1542\/peds.2017-0044","article-title":"Ending the culture of culture-negative sepsis in the neonatal ICU","volume":"140","author":"Cantey","year":"2017","journal-title":"Pediatrics."},{"key":"B14","doi-asserted-by":"publisher","first-page":"826","DOI":"10.1542\/peds.2014-3409","article-title":"Neonatal intensive care unit antibiotic use","volume":"135","author":"Schulman","year":"2015","journal-title":"Pediatrics."},{"key":"B15","doi-asserted-by":"publisher","first-page":"239","DOI":"10.1080\/17512433.2017.1279968","article-title":"Antimicrobial dosing in neonates","volume":"10","author":"Kontou","year":"2017","journal-title":"Exp Rev Clin Pharmacol."},{"key":"B16","doi-asserted-by":"publisher","first-page":"384","DOI":"10.1097\/INF.0000000000002106","article-title":"Potential for more rational use of antibiotics in hospitalized children in a country with low resistance - data from eight point prevalence surveys","volume":"38","author":"Thaulow","year":"2018","journal-title":"Pediatr Infect Dis J."},{"key":"B17","article-title":"Point prevalence survey of healthcareassociated infections and antimicrobial use in European acute care hospitals \u2013 protocol version 4.3.","year":"2012"},{"key":"B18","unstructured":"Forslag til Enhetlige Nasjonale Kriterier for Diagnosekoder i Nyf\u00f8dtmedisin (In Norwegian)"},{"key":"B19","doi-asserted-by":"publisher","first-page":"817","DOI":"10.1542\/peds.2010-2217","article-title":"Early onset neonatal sepsis: the burden of group B Streptococcal and E. coli disease continues","volume":"127","author":"Stoll","year":"2011","journal-title":"Pediatrics."},{"key":"B20","doi-asserted-by":"publisher","first-page":"125","DOI":"10.1016\/j.ijid.2017.01.006","article-title":"Late-onset neonatal sepsis in Arab states in the Gulf region: two-year prospective study","volume":"55","author":"Hammoud","year":"2017","journal-title":"Int J Infect Dis."},{"key":"B21","doi-asserted-by":"publisher","first-page":"901","DOI":"10.1097\/01.inf.0000180471.03702.7f","article-title":"Clinical and epidemiologic characteristics of viral infections in a neonatal intensive care unit during a 12-year period","volume":"24","author":"Verboon-Maciolek","year":"2005","journal-title":"Pediatr Infect Dis J."},{"key":"B22","doi-asserted-by":"publisher","first-page":"489","DOI":"10.1007\/s00431-013-2194-1","article-title":"High-dose gentamicin in newborn infants: is it safe?","volume":"173","author":"Fjalstad","year":"2013","journal-title":"Eur J Pediatr."},{"key":"B23","article-title":"Metodebok i Nyf\u00f8dtmedisin (in Norwegian)","year":"2012"},{"key":"B24","doi-asserted-by":"publisher","first-page":"325","DOI":"10.3389\/fped.2018.00325","article-title":"Key Components for antibiotic dose optimization of sepsis in neonates and infants","volume":"6","author":"van Donge","year":"2018","journal-title":"Front Pediatr."},{"key":"B25","doi-asserted-by":"publisher","first-page":"496","DOI":"10.1203\/00006450-198104001-00346","article-title":"Tobramycin versus gentamicin for the neonate","volume":"15","author":"Itsarayoungyuen","year":"1981","journal-title":"Pediatr Res."},{"key":"B26","doi-asserted-by":"publisher","first-page":"166","DOI":"10.2165\/00003495-197612030-00002","article-title":"Tobramycin: a review of its antibacterial and pharmacokinetic properties and therapeutic use","volume":"12","author":"Brogden","year":"1976","journal-title":"Drugs."},{"key":"B27","doi-asserted-by":"publisher","first-page":"e269","DOI":"10.1542\/peds.2004-1833","article-title":"Late-onset septicemia in a Norwegian national cohort of extremely premature infants receiving very early full human milk feeding","volume":"115","author":"Ronnestad","year":"2005","journal-title":"Pediatrics."},{"key":"B28","doi-asserted-by":"publisher","first-page":"741","DOI":"10.1007\/s00431-018-3113-2","article-title":"Sepsis calculator implementation reduces empiric antibiotics for suspected early-onset sepsis","volume":"177","author":"Achten","year":"2018","journal-title":"Eur J Pediatr."},{"key":"B29","doi-asserted-by":"publisher","first-page":"30","DOI":"10.1542\/peds.2013-1689","article-title":"Stratification of risk of early-onset sepsis in newborns \u2265 34 weeks' gestation","volume":"133","author":"Escobar","year":"2014","journal-title":"Pediatrics."},{"key":"B30","doi-asserted-by":"publisher","first-page":"365","DOI":"10.1001\/jamapediatrics.2016.4678","article-title":"A quantitative, risk-based approach to the management of neonatal early-onset sepsis","volume":"171","author":"Kuzniewicz","year":"2017","journal-title":"JAMA Pediatr."},{"key":"B31","doi-asserted-by":"publisher","first-page":"285","DOI":"10.3389\/fped.2018.00285","article-title":"Culture-negative early-onset neonatal sepsis - at the crossroad between efficient sepsis care and antimicrobial stewardship","volume":"6","author":"Klingenberg","year":"2018","journal-title":"Front Pediatr."},{"key":"B32","doi-asserted-by":"publisher","first-page":"871","DOI":"10.1016\/S0140-6736(17)31444-7","article-title":"Procalcitonin-guided decision making for duration of antibiotic therapy in neonates with suspected early-onset sepsis: a multicentre, randomised controlled trial (NeoPIns)","volume":"390","author":"Stocker","year":"2017","journal-title":"Lancet."},{"key":"B33","doi-asserted-by":"publisher","first-page":"e180164","DOI":"10.1001\/jamanetworkopen.2018.0164","article-title":"Temporal trends and center variation in early antibiotic use among premature infants","volume":"1","author":"Flannery","year":"2018","journal-title":"JAMA Network Open."},{"key":"B34","doi-asserted-by":"publisher","first-page":"S77","DOI":"10.1016\/j.jinf.2016.04.026","article-title":"Recognising early onset neonatal sepsis: an essential step in appropriate antimicrobial use","volume":"72","author":"van Herk","year":"2016","journal-title":"J Infect."},{"key":"B35","doi-asserted-by":"publisher","first-page":"528","DOI":"10.1097\/INF.0000000000002182","article-title":"Minimum duration of antibiotic treatment based on blood culture in ruled out neonatal sepsis","volume":"38","author":"Durrani","year":"2018","journal-title":"Pediatr Infect Dis J."},{"key":"B36","doi-asserted-by":"publisher","first-page":"310","DOI":"10.1093\/jpids\/piy043","article-title":"Antibiotic stewardship in the neonatal intensive care unit: effects of an automatic 48-hour antibiotic stop order on antibiotic use","volume":"8","author":"Astorga","year":"2018","journal-title":"J Pediatric Infect Dis Soc."},{"key":"B37","doi-asserted-by":"publisher","first-page":"1178","DOI":"10.1016\/S1473-3099(16)30205-5","article-title":"Reducing unnecessary antibiotic use in the neonatal intensive care unit (SCOUT): a prospective interrupted time-series study","volume":"16","author":"Cantey","year":"2016","journal-title":"Lancet Infect Dis."},{"key":"B38","doi-asserted-by":"publisher","first-page":"626","DOI":"10.1111\/apa.14578","article-title":"Serum concentrations of C-reactive protein in healthy term-born Norwegian infants 48\u201372 hours after birth","volume":"108","author":"Mjelle","year":"2018","journal-title":"Acta Paediatr."},{"key":"B39","doi-asserted-by":"publisher","first-page":"1646","DOI":"10.1080\/14767058.2017.1322060","article-title":"Biomarkers for diagnosis of neonatal sepsis: a literature review","volume":"31","author":"Sharma","year":"2018","journal-title":"J Matern Fetal Neonatal Med."},{"key":"B40","doi-asserted-by":"publisher","first-page":"375","DOI":"10.1111\/apa.13698","article-title":"Management of early-onset neonatal sepsis differs in the north and south of Scandinavia","volume":"106","author":"Drageset","year":"2017","journal-title":"Acta Paediatr."},{"key":"B41","doi-asserted-by":"publisher","first-page":"1106","DOI":"10.1093\/jac\/dkv418","article-title":"The worldwide antibiotic resistance and prescribing in european children (ARPEC) point prevalence survey: developing hospital-quality indicators of antibiotic prescribing for children","volume":"71","author":"Versporten","year":"2016","journal-title":"J Antimicrob Chemother."},{"key":"B42","unstructured":"Smittevernveiledern\n            BlystadH"},{"key":"B43","doi-asserted-by":"publisher","first-page":"135","DOI":"10.1016\/j.jhin.2007.07.026","article-title":"Risk factors for extended-spectrum beta-lactamase-producing Serratia marcescens and Klebsiella pneumoniae acquisition in a neonatal intensive care unit","volume":"67","author":"Crivaro","year":"2007","journal-title":"J Hosp Infect."},{"key":"B44","doi-asserted-by":"publisher","first-page":"665","DOI":"10.1111\/j.1651-2227.2010.01687.x","article-title":"Comparison of ampicillin plus gentamicin vs. penicillin plus gentamicin in empiric treatment of neonates at risk of early onset sepsis","volume":"99","author":"Metsvaht","year":"2010","journal-title":"Acta Paediatr."},{"key":"B45","doi-asserted-by":"publisher","first-page":"443","DOI":"10.1542\/peds.2009-2959","article-title":"Neonatal outcomes of extremely preterm infants from the NICHD Neonatal Research Network","volume":"126","author":"Stoll","year":"2010","journal-title":"Pediatrics."},{"key":"B46","doi-asserted-by":"publisher","first-page":"52","DOI":"10.1097\/ANC.0000000000000164","article-title":"Sustained reduction in bloodstream infections in infants at a large tertiary care neonatal intensive care unit","volume":"16","author":"Neill","year":"2016","journal-title":"Adv Neonatal Care."},{"key":"B47","doi-asserted-by":"publisher","first-page":"e20170925","DOI":"10.1542\/peds.2017-0925","article-title":"Identification of extremely premature infants at low risk for early-onset sepsis","volume":"140","author":"Puopolo","year":"2017","journal-title":"Pediatrics."}],"updated-by":[{"DOI":"10.3389\/fped.2022.862484","type":"corrigendum","label":"Corrigendum","source":"publisher","updated":{"date-parts":[[2022,3,10]],"date-time":"2022-03-10T00:00:00Z","timestamp":1646870400000}}],"container-title":["Frontiers in Pediatrics"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fped.2019.00440\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,3,10]],"date-time":"2022-03-10T18:25:47Z","timestamp":1646936747000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fped.2019.00440\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019,10,24]]},"references-count":47,"alternative-id":["10.3389\/fped.2019.00440"],"URL":"https:\/\/doi.org\/10.3389\/fped.2019.00440","relation":{"corrigendum":[{"id-type":"doi","id":"10.3389\/fped.2022.862484","asserted-by":"object"}]},"ISSN":["2296-2360"],"issn-type":[{"value":"2296-2360","type":"electronic"}],"subject":[],"published":{"date-parts":[[2019,10,24]]},"article-number":"440"}}