Impact of early life antibiotic exposure on the preschool developmental status: a nationwide population-based study

Abstract

Objective Growing concerns exist about the potential adverse effects of early antibiotic exposure on neurodevelopmental outcomes. However, large-scale studies exploring these implications in early childhood are rare. Design A nationwide, population-based retrospective cohort study using data from the Korean National Health Insurance System and the National Health Screening Program for Infants and Children (NHSPIC) between 2015 and 2022. Patients A total of 1 848 841 children who participated in the NHSPIC at both 4–6 months and 54–60 months of age were included. Interventions Antibiotic exposure under 90 days old. Main outcome measures Developmental delays in preschool-aged children assessed by the Korean Developmental Screening Test at 54–60 month of age. Results Among the 1 848 841 children assessed, 23% experienced antibiotic exposure within the first 3 months of life. Early use of antibiotics was linked to a slightly elevated risk of developmental delays at a median age of 4.94 years (OR 1.03, 95% CI 1.00 to 1.17), particularly affecting gross motor (OR 1.08, 95% CI 1.04 to 1.13), fine motor (OR 1.09, 95% CI 1.05 to 1.13), cognition (OR 1.08, 95% CI 1.04 to 1.13) and communication (OR 1.08, 95% CI 1.04 to 1.12). A dose-response relationship was also observed, with longer durations of antibiotic exposure associated with an increased risk of developmental delays. Conclusions Exposure to antibiotics in infants under 90 days old may be associated with a modest increase in the risk of global developmental delays, especially in motor skills, cognitive functions and communication abilities. Careful consideration is necessary when prescribing antibiotics to this age group.