{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,30]],"date-time":"2025-10-30T17:40:30Z","timestamp":1761846030073,"version":"build-2065373602"},"reference-count":184,"publisher":"MDPI AG","issue":"9","license":[{"start":{"date-parts":[[2025,9,16]],"date-time":"2025-09-16T00:00:00Z","timestamp":1757980800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Medical University of Sofia and the European Union\u2014NextGenerationEU through the National Recovery and Resilience Plan of the Republic of Bulgaria","award":["BG-RRP-2.004-0004-C01"],"award-info":[{"award-number":["BG-RRP-2.004-0004-C01"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Antibiotics"],"abstract":"<jats:p>Premature infants are an especially vulnerable group that often needs extended intensive care. Prematurity naturally hampers the development of the immune system, significantly increasing the risk of infections. In the Neonatal Intensive Care Unit (NICU), antibiotic treatment is often a crucial, life-saving measure. For parents, the birth of a very preterm infant (before 32 weeks of gestation) turns what should be a happy event into a period filled with deep uncertainty and distress. Maintaining hope amid these difficulties relies heavily on maintaining regular communication with and trusting the medical team. Clinical realities in the NICU include a high risk of infection that requires multiple medications, including antibiotics. There is an inverse relationship between gestational age and pharmaceutical exposure. Parents worry about the amount of medication their child receives and the potential long-term effects on development. Over the past thirty years, initiatives such as antimicrobial stewardship programs have worked to reduce antibiotic use and treatment duration in the NICU, emphasizing proper care for premature infants worldwide. This article examines the ethical landscape from the perspectives of three primary stakeholders: parents, healthcare providers, and regulatory bodies. The key ethical question is whether these groups achieve meaningful cooperation or if institutional and professional priorities overshadow clinical practice. In the NICU, decision-making responsibility mainly lies with the medical team, as parents often have limited influence over treatment decisions, and regulatory oversight usually occurs indirectly. This concentration of authority underscores the complex and critical nature of neonatal intensive care.<\/jats:p>","DOI":"10.3390\/antibiotics14090936","type":"journal-article","created":{"date-parts":[[2025,9,17]],"date-time":"2025-09-17T05:59:51Z","timestamp":1758088791000},"page":"936","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Neonatology: First Exposure to Antibiotics from the Ethical Perspective of Parents, Physicians, and Regulators"],"prefix":"10.3390","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1495-9517","authenticated-orcid":false,"given":"Iliya","family":"Mangarov","sequence":"first","affiliation":[{"name":"Department of Neonatology, University Hospital \u201cSofiaMed\u201d, Faculty of Medicine, Sofia University St. Kliment Ohridski, 1504 Sofia, Bulgaria"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Simeon","family":"Iliev","sequence":"additional","affiliation":[{"name":"Independent Researcher, 1680 Sofia, Bulgaria"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yulian","family":"Voynikov","sequence":"additional","affiliation":[{"name":"Department of Chemistry, Faculty of Pharmacy, Medical University, 1000 Sofia, Bulgaria"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6938-1054","authenticated-orcid":false,"given":"Valentina","family":"Petkova","sequence":"additional","affiliation":[{"name":"Department of Organization and Economics of Pharmacy, Faculty of Pharmacy, Medical University of Sofia, 1000 Sofia, Bulgaria"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Iva","family":"Parvova","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Clinic of Rheumatology, St. Anna University Hospital, Medical University of Sofia, 1750 Sofia, Bulgaria"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6072-513X","authenticated-orcid":false,"given":"Antoaneta","family":"Tsvetkova","sequence":"additional","affiliation":[{"name":"Medical College, Medical University of Varna, 9002 Varna, Bulgaria"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2320-8472","authenticated-orcid":false,"given":"Irina","family":"Nikolova","sequence":"additional","affiliation":[{"name":"Department of Pharmacology, Pharmacotherapy and Toxicology, Faculty of Pharmacy, Medical University of Sofia, 1000 Sofia, Bulgaria"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2025,9,16]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1133","DOI":"10.1542\/peds.2007-2683","article-title":"The changing face of preterm birth","volume":"120","author":"Merialdi","year":"2007","journal-title":"Pediatrics"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"S2","DOI":"10.1186\/1742-4755-10-S1-S2","article-title":"Born too soon: The global epidemiology of 15 million preterm births","volume":"10","author":"Blencowe","year":"2013","journal-title":"Reprod. 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