Early Childhood Antibiotics and Chronic Pediatric Conditions: A Retrospective Cohort Study
Bibliographic record
Abstract
BACKGROUND: Early childhood antibiotics have been implicated in chronic pediatric conditions, but many studies leave concerns about unmeasured confounding. We evaluated associations between early childhood antibiotics and multiple pediatric conditions. METHODS: We performed a retrospective cohort study using electronic health records data (United Kingdom, 1987-2020). The primary exposure was antibiotic prescriptions between birth and age 2 years. Outcomes were newly diagnosed chronic pediatric conditions (asthma/allergic, autoimmune, neurodevelopmental/psychiatric) or forearm fracture (negative control). Hazard ratios (HRs) with 95% confidence intervals (CIs) were estimated using multivariable Cox regression models adjusted for maternal, child, and area-based socioeconomic covariates. Sibling-matched analyses were conducted using conditional Cox regression. RESULTS: Among 1 091 449 children, antibiotic exposure before age 2 was positively associated with asthma (HR, 1.24 [95% CI, 1.22-1.26]), food allergy (HR, 1.33 [95% CI, 1.26-1.40]), and allergic rhinitis (HR, 1.06 [95% CI, 1.03-1.10]), with stronger associations with multiple antibiotic courses. Sibling-matched analyses yielded similar findings. Early childhood antibiotic exposure was also dose-dependently associated with intellectual disability (≥5 vs 1-2 courses: HR, 1.73 [95% CI, 1.49-2.01]; sibling-matched: HR, 2.79 [95% CI, 1.87-4.18]). Consistent associations were not observed for celiac disease, inflammatory bowel disease, juvenile idiopathic arthritis, psoriasis, type 1 diabetes, attention-deficit/hyperactivity disorder, autism spectrum disorders, or anxiety. Sibling-matched results and a negative control outcome suggested minimal confounding. CONCLUSIONS: Children receiving multiple antibiotic courses before age 2 were more likely to develop asthma, food allergies, allergic rhinitis, and intellectual disability. However, antibiotic-associated risks of most autoimmune, neurodevelopmental, and psychiatric conditions studied were minimal.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".