Acta Paediatrica, Volume 115, Issue 2, Page 309-318, February 2026.
Lisanne M. van Leeuwen, Gina J. van Beveren, Marieke A. G. Peeters, Dennis Souverein, Sjoerd Euser, Debby Bogaert, Marlies A. van Houten
Aim
We examined the relationship between early-life antibiotics, different regimens, and growth until age five years.
Methods
Data from two parallel birth cohorts were analysed: 128 healthy term-born children and 147 term-born children who received antibiotics for suspected neonatal sepsis, randomised across three regimens: Amoxicillin+Cefotaxime, Augmentin+Gentamicin, Penicillin+Gentamicin. Until age five years, growth, environmental exposures, diet, and physical activity data were collected. Primary outcomes were weight-for-age, height-for-age, and weight-for-height z-scores with early-life antibiotic exposure and the regimen as determinants of interest.
Results
The median antibiotic exposure duration was 3 days (interquartile range 2.4–5.5 days). Children exposed to early-life antibiotics had on average 0.26 lower weight-for-height z-scores over the first five years compared to unexposed controls (p = 0.014). Especially children treated with Augmentin+Gentamicin showed lower weight-for-height z-scores, compared to unexposed controls (coefficient = 0.36; p = 0.013). Additionally, at age five years, higher birth weight percentiles were associated with higher weight-for-age, height-for-age and weight-for-height and weekly lemonade consumption was associated with higher weight-for-age z-scores.
Conclusion
Antibiotics in the first week of life are associated with lower weight-for-height up to age five years, with effects varying by treatment type. To explain these effects, further examination of antimicrobial-induced early-life microbiome perturbations and subsequent growth is needed.
Trial Registration
International Clinical Trial Registry Platform (https://trialsearch.who.int/): NL4882 and NL3821
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