Using antibiotics wisely in the neonatal unit

Researcher Joseph Ting leads Canada-wide project to develop guidelines for treating premature babies with antibiotic drugs 

Joseph Ting photo: supplied

As a neonatologist, Joseph Ting relies on antibiotics to treat pre-term babies who sometimes develop life-threatening infections after birth.

As a research scientist, Ting is working to ensure that those antibiotics are used wisely in the neonatal unit, to prevent the emergence of antibiotic-resistant organisms (“superbugs”) and to reduce the longer-term impacts of the drugs on the babies’ health. 

His career as a physician and a researcher brought Ting from the University of British Columbia to the University of Alberta in 2021. He is now an associate professor in the Department of Pediatrics and a neonatologist at the Stollery Children’s Hospital. “This is an excellent research opportunity that I have been dreaming of for years,” says Ting, who received a Variety, the Children’s Charity and Stollery Children’s Hospital Foundation Pediatric Clinical Research Professorship to focus more of his time on research. Ting also received start-up funding from WCHRI for his program.

His main research focus is on neonatal infections and the judicious use of antibiotics in premature babies, and the childhood outcomes of these high-risk infants. Ting is also beginning to study the health outcomes in newborns exposed to COVID-19, working with other research groups across the country.

In 2019, he began leading a Canada-wide project through the Canadian Neonatal Network to develop a national neonatal intensive-care antibiotic stewardship plan that promotes more rational use of antibiotics. The study, funded by the Canadian Institutes of Health Research, involves more than 20 medical centres and runs for six years.

The issue of antibiotic use in the neonatal unit is challenging because the risks are high. About one-tenth of all babies are born before 37 weeks of pregnancy. The earlier they are born, the more prone they are to sepsis, an infection in the bloodstream that sometimes leads to organ failure. These infections are among the leading causes of death among preterm babies, especially if they are born very early.

“The difficulty in small babies particularly is that the signs of infections are very subtle,” says Ting. Physicians can’t wait for test results to come back from the lab because, by then, it could be too late to save the baby. 

“When we suspect newborn infections, we have to start antibiotics, there’s no doubt about that,” explains Ting. What he advocates is controlling how long babies remain on antibiotics and what types are used. For example, if a baby’s lab results come back negative for an infection, the physician should consider stopping the antimicrobials early, says Ting.

Even when an infection is confirmed, using a narrow-spectrum antimicrobial targeted at specific pathogens could be a better choice than a wide-spectrum, ‘big gun’ approach.

And because antibiotics can have an impact on a baby’s body — disturbing the equilibrium of gut bacteria that may result in more drug-resistant bugs taking over, for example — a shorter, more narrowly focused course of antibiotics is a preferable course of action, he says.

“Antibiotics are our friends. We have to use them in the right way.”

Joseph Ting is supported by the Stollery Children’s Hospital Foundation through the Women and Children Health Research Institute.