2026 Southeastern Residency Conference

Title: The Impact of Inhaled Antibiotic Use in Critically Ill Neonatal and Pediatric Populations
Authors: Madeline DiCenso, Andrea Gerwin, Renee Hughes, Paige Klingborg
Background/Purpose: Pediatric and neonatal patients with chronic lung disease or tracheostomies face an elevated risk of pulmonary bacterial infections due to impaired airway clearance and chronic colonization. Prophylactic inhaled antibiotic (iAbx) use is described in cystic fibrosis (CF) patients but is minimally explored in tracheostomized and critically ill children without CF. Retrospective data suggests benefits to prophylactic iAbx therapy, including reduced rates of re-hospitalization and systemic antibiotic use with minimal associated side effects. However, published guidelines directing use do not currently exist. This study will describe our institution’s use of iAbx in critically ill pediatric and neonatal patients, evaluate optimal dosing strategies, and analyze potential improvements in clinical outcomes.
Methods: This was a single center, retrospective, observational chart review conducted using electronic health records from patients admitted to the neonatal intensive care unit (NICU) and pediatric intensive care unit (PICU) at Children’s Hospital at Erlanger between July 1, 2022, and July 1, 2025. Patients were included if they received iAbx during admission. Patients who did not receive iAbx or with Cystic Fibrosis were excluded. The primary outcome of the study was to describe the usage patterns of iAbx in the NICU and PICU. The secondary outcomes were to evaluate potential benefits of continuous or cycled use of iAbx and to analyze how use of inhaled antibiotics may impact clinical and functional outcomes, such as respiratory status, and days of systemic antibiotics. Due to the young age of our study population, we evaluated days of systemic antibiotics compared to days of life (DoL). Safety outcomes included resistance patterns, and hearing screen results.
Results: Preliminary results on utilization patterns indicate that mean age at initiation of therapy was 29.71 months (1–204-month range). Tobramycin was nebulized at a dose of 300 mg twice daily with the most common duration therapy of 28 days. Before iAbx therapy was initiated, patients had fewer average systemic abx days per DoL (1:14.07) compared to an increased ratio (1:9.54) after iAbx. Fraction of inhaled oxygen (FiO2) requirements were higher in the 14 days prior to iAbx initiation (average 36.7%) compared to the 14 days following iAbx initiation (average 29.7%). Data regarding the safety profile of inhaled antibiotic therapy is still in process.
Conclusions: The use of iAbx in critically ill pediatric patients at Children’s Hospital at Erlanger closely matches regimens presented in other primary literature. There may be an improvement in respiratory status represented by improved ventilator settings associated with use of inhaled antibiotic therapy. Although systemic antibiotic days normalized for DoL increased after therapy initiation, interpretation is limited by varied initiation times, with post‑treatment data constrained by the study’s fixed endpoint. Data regarding safety of inhaled antibiotic therapy and resistance patterns amongst the trial population is ongoing.