Antibiotic exposure at the beginning of life can lead to increased antimicrobial resistance and perturbations of the developing microbiome. Early-life microbiome disruption increases the risks of developing chronic diseases later in life. Fear of missing evolving neonatal sepsis is the key driver for antibiotic overtreatment early in life. Bias (a systemic deviation towards overtreatment) and noise (a random scatter) affect the decision-making process. In this perspective, we advocate for a factual approach quantifying the burden of treatment in relation to the burden of disease balancing antimicrobial stewardship and effective sepsis management.

Biostatistics and Methodology CTU CS Department of Health Sciences and Medicine University of Lucerne Luzern Switzerland

Clinic of Neonatology Department Mother Woman Child Lausanne University Hospital and University of Lausanne Lausanne Switzerland

Department of Clinical Science Intervention and Technology Karolinska Institutet Stockholm Sweden

Department of Neonatology and Neonatal Intensive Care Medical University of Warsaw Warszawa Poland

Department of Neonatology Karolinska University Hospital Stockholm Sweden

Department of Neonatology Thomayer University Hospital Prague Prague Czech Republic

Department of Paediatrics University of Szeged Szeged Hungary

Department of Pediatrics Children's Hospital Lucerne Lucerne Switzerland

Department of Pediatrics Inselspital Bern University Hospital University of Bern Bern Switzerland

Department of Pediatrics Women and Infants Hospital of Rhode Island Warren Alpert Medical School of Brown University Richmond USA

Dept of Pediatrics and Adolescence Medicine University Hospital of North Norway Tromsø Norway

Division of Neonatology Department of Pediatrics McMaster Children's Hospital McMaster University Hamilton Health Sciences Hamilton Canada

Institute of Clinical Medicine University of Oslo and Oslo University Hospital Oslo Norway

Neonatal Directorate Child and Adolescent Health Service King Edward Memorial Hospital Perth Western Australia

Neonatal Intensive Care Unit Mother and Child Department Policlinico University Hospital Modena Italy

Neonatal Unit Department of Obstetrics and Gynecology Motol University Hospital Prague Prague Czech Republic

Neonatologia e Terapia Intensiva Neonatale University of Bari Bari Italy

Neonatology and Neonatal Intensive Care Unit CHIREC Delta Hospital Brussels Belgium

Neonatology and Neonatal Intensive Care Unit Ecclesiastical General Hospital F Miulli Acquaviva delle Fonti Italy

Neonatology and Neonatal Intensive Care Unit Policlinico Riuniti Foggia Foggia Italy

Neonatology and Paediatric Intensive Care Unit Geneva University Hospitals and Geneva University Geneva Switzerland

Paediatric Research Group Faculty of Health Sciences UiT The Arctic University of Norway Tromsø Norway

Perinatal Intensive Care Unit Department of Obstetrics and Gynaecology Semmelweis University Budapest Hungary

Service néonatal Clinique CHC Montlegia groupe santé CHC Liège Belgium

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