Implementation of an Automatic Stop Order and Initial Antibiotic Exposure in Very Low Birth Weight Infants

Veeral N. Tolia*, Sujata Desai, Huanying Qin, Polli D. Rayburn, Grace Poon, Karna Murthy, Dan L. Ellsbury, Arpitha Chiruvolu

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

29 Scopus citations


Objective To evaluate if an antibiotic automatic stop order (ASO) changed early antibiotic exposure (use in the first 7 days of life) or clinical outcomes in very low birth weight (VLBW) infants. Study Design We compared birth characteristics, early antibiotic exposure, morbidity, and mortality data in VLBW infants (with birth weight <= 1500 g) born 2 years before (pre-ASO group, n = 313) to infants born in the 2 years after (post-ASO, n = 361) implementation of an ASO guideline. Early antibiotic exposure was quantified by days of therapy (DOT) and antibiotic use > 48 hours. Secondary outcomes included mortality, early mortality, early onset sepsis (EOS), and necrotizing enterocolitis. Results Birth characteristics were similar between the two groups. We observed reduced median antibiotic exposure (pre-ASO: 6.5 DOT vs. Post-ASO: 4 DOT; p < 0.001), and a lower percentage of infants with antibiotic use > 48 hours (63.4 vs. 41.3%; p < 0.001). There were no differences in mortality (12.1 vs 10.2%; p = 0.44), early mortality, or other reported morbidities. EOS accounted for less than 10% of early antibiotic use. Conclusion Early antibiotic exposure was reduced after the implementation of an ASO without changes in observed outcomes.

Original languageEnglish (US)
Pages (from-to)105-110
Number of pages6
JournalAmerican journal of perinatology
Issue number2
StatePublished - Jan 1 2017


  • NICU
  • antibiotic stewardship
  • automatic stop order
  • very low birth weight infants

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Obstetrics and Gynecology


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