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Background Although antibiotics are often indicated to treat early-life infections, such exposure may lead to serious adverse outcomes. Few studies have characterized patterns of antibiotic use among neonatal intensive care units (NICUs). Methods We performed a cross-sectional study of antibiotic use in 51 NICUs participating in the Pediatric Health Information System (PHIS), a database that includes clinical and resource utilization data for standalone children’s hospitals in the United States. Assessments were conducted on a single mid-week day of 2017. We examined the use of any antibiotic and broad-spectrum antibiotics using charge data in children admitted in each NICU on the study day. We compared antibiotic use among NICUs and geographical regions, and assessed its association with the NICU median case mix index (CMI) (as a surrogate for clinical complexity). Results 2813 infants were hospitalized in NICUs on the study day; the median number of patients at each study site was 47 (IQR = 34 – 62). 90% were &lt;1 month old, 56% were male, 46% were white, and 62% were extremely/very preterm. Overall, 23% received at least one antibiotic and 6% received broad-spectrum antibiotics. Broad-spectrum antibiotic use was twice as prevalent in surgical compared with medical patients. Antibiotic use prevalence varied by region, ranging from 19% in the Midwest to 26% in the West (table). Ampicillin, gentamicin and vancomycin were the most common antibiotics used (25.2%, 18.8% and 9.9%, respectively). Antibiotic use prevalence varied substantially across NICUs (Figure 1). There was a moderate but significant positive correlation between overall or broad-spectrum antibiotic use and median NICU CMI (Figure 2). Conclusion There is substantial variability in antibiotic use among US NICUs, which seems partially explained by patient case-mix. Additional studies are needed to identify drivers of unwarranted variability in antibiotic use among NICUs. Disclosures Ritu Banerjee, MD, PhD, Accelerate Diagnostics: Grant/Research Support; BioFire: Research Grant; Biomerieux: Research Grant; Roche: Research Grant.

1137. Variability of Antibiotic Use in Neonatal Intensive Care Units in the United States