Secondary Logo

Journal Logo

Institutional members access full text with Ovid®

Antibiotic Treatment in the First Week of Life Impacts the Growth Trajectory in the First Year of Life in Term Infants

Kamphorst, Kim*,†; Oosterloo, Berthe C.*; Vlieger, Arine M.; Rutten, Nicole B.; Bunkers, Carin M.; Wit, Ernst C.; van Elburg, Ruurd M.*,§

Journal of Pediatric Gastroenterology and Nutrition: July 2019 - Volume 69 - Issue 1 - p 131–136
doi: 10.1097/MPG.0000000000002360
Original Articles: Nutrition

Objective: Antibiotic treatment in early life appears to increase the risk for childhood overweight and obesity. So far, the association between antibiotics administrated specifically during the first week of life and growth has not been studied. Therefore, we studied the association between growth and antibiotics, given in the first week of life and antibiotic courses later in the first year of life.

Method: A prospective observational birth cohort of 436 term infants with 151 receiving broad-spectrum antibiotics for suspected neonatal infection (AB+), and 285 healthy controls (AB−) was followed during their first year. Weight, height, and additional antibiotic courses were collected monthly. A generalized-additive-mixed-effects model was used to fit the growth data. Growth curve estimation was controlled for differences in sex, gestational age, delivery mode, exclusive breast-feeding, tobacco exposure, presence of siblings, and additional antibiotic courses.

Results: Weight-for-age and length-for-age increase was lower in AB+ compared with AB− (P < 0.0001), resulting in a lower weight and length increase 6.26 kg (standard error [SE] 0.07 kg) and 25.4 cm (SE 0.27 cm) versus 6.47 kg (SE 0.06 kg) and 26.4 cm (SE 0.21 cm) (P < 0.05 and P < 0.005, respectively) in the first year of life. Approximately 30% of the children in both groups received additional antibiotic course(s) in their first year, whereafter additional weight gain of 76 g per course was observed (P = 0.0285).

Conclusions: Decreased growth was observed after antibiotics in the first week of life, whereas increased growth was observed after later antibiotic course(s) in term born infants in the first year of life. Therefore, timing of antibiotics may determine the association with growth.

*Department of Pediatrics, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam Gastroenterology, Metabolism and Nutrition, Amsterdam Reproduction and Development, Amsterdam

St. Antonius Hospital, Department of Pediatrics, Nieuwegein, The Netherlands

Institute of Computational Science, USI, Switzerland

§Danone Nutricia Research, Utrecht, The Netherlands.

Address correspondence and reprint requests to Kim Kamphorst, MSc, Emma Children's Hospital, Amsterdam UMC, Room H8.235, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands (e-mail:

Received 8 December, 2018

Accepted 23 March, 2019

This study was registered at, registration number NCT02536560 (

This study was funded by “Agentschap NL,” grant number FND-06015, by Nutricia Netherlands B.V. as part of a public private partnership, and by the Christina Bader foundation (CBSIKZ).

K.K. and B.C.O. contributed equally.

The authors report no conflicts of interest.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text, and links to the digital files are provided in the HTML text of this article on the journal's Web site (

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Website (

© 2019 by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology,