Dogan KAYMAZ, Deniz UZUN, Ferhan DEMIRTAS, Yasemin Ezgi KOSTEKCI, Emel OKULU, Omer ERDEVE, Begum ATASAY, Saadet ARSAN
Turkish Archives of Pediatrics - 2026;61(8):703-709
Objective: To evaluate the impact of the 2023 national guideline revision, which increased the gestational age threshold for empirical antibiotic initiation from <34 to <35 weeks, on hospitalization and antibiotic exposure in infants born at 340/7-346/7 weeks. Methods: This single-center retrospective cohort study included all live-born infants at 340/7-346/7 weeks between April 2018 and September 2023. The same cohort was reassessed according to the 2018 and 2023 Turkish Neonatology Society's national guidelines on the Diagnosis and Treatment of Neonatal Infections criteria. For each infant, neonatal intensive care unit (NICU) admission, empirical antibiotic use, and hospitalization duration were recalculated under both scenarios. Results: A total of 272 infants were included. Under the 2018 guideline, 68 infants (25.0%) required empirical antibiotics, whereas the 2023 guideline classified 197 infants (72.4%) as needing treatment, adding 129 newly eligible infants. Among these, 66 infants who had previously roomed-in required new NICU admission, increasing total admissions from 183 (67.3%) to 249 (91.5%). Median antibiotic duration increased from 0 days to 2 days, and median hospitalization increased from 5 to 6 days (both P < .001). None of the newly classified infants developed clinical or culture-proven early-onset neonatal sepsis (EONS). Conclusion: Raising the gestational age threshold to <35 weeks substantially increased empirical antibiotic use and NICU admissions without improving EONS detection. These findings highlight the need for more refined and clinically integrated risk-stratification strategies and underscore the broader implications of unnecessary antibiotic exposure, including increased NICU utilization, healthcare burden, and antimicrobial stewardship concerns.
