May 20, 2022

Infants in low-risk deliveries should not need antibiotics at birth, study finds

According to a study conducted by researchers at the Children’s Hospital of Philadelphia (CHOP), infants born by caesarean section without complications, without labor or rupture of membrane before delivery and without risk of infection, should not need antibiotics at the birth. The results, which were published today in Pediatrics, could help clinicians tailor the early use of antibiotics in neonates. Only those deemed to be at risk of infection should receive antibiotics, thereby reducing unnecessary use.

“Given the risks associated with early sepsis in infants, it is not surprising that newborns often receive antibiotics immediately after birth,” said first author Dustin D. Flannery, DO, MSCE, neonatologist and clinical researcher at Children’s Hospital. of Philadelphia. “However, our study shows that it is safe not to take antibiotics in infants, including those born preterm, with low-risk delivery characteristics. These infants are unlikely to be infected at birth. birth and can be spared potential complications from systemic exposure to antibiotics.”

Newborns are at risk for early onset sepsis (EOS), a life-threatening infection that can occur within 72 hours of birth, due to exposure to bacteria during the birthing process. However, it is difficult to predict which infants will develop EOS. This led to an order of magnitude higher rate of antibiotic use compared to the rate of infants with confirmed infection. Prolonged use of antibiotics in newborns is associated with serious adverse effects in preterm infants and potential long-standing complications in term infants, highlighting the need for a better way to assess the risk of infection.

Since the primary way a newborn is exposed to bacteria is through the birthing process, the researchers decided to analyze birthing characteristics to see if they could help providers identify infants at lower risk. of EOS. In a retrospective study, they evaluated all infants born between 2009 and 2014 at two Philadelphia birthing hospitals who had a blood or cerebrospinal fluid culture obtained within 72 hours of birth. They reviewed medical record data for confirmed infection and for delivery characteristics, defining a “low risk” delivery as a caesarean section, with no rupture of amniotic membranes prior to delivery; absence from work or attempts to induce labor; and an absence of suspected or confirmed maternal intra-amniotic infection or fetal distress.

The researchers also included infants born across the gestational age spectrum. Previous studies have assessed the risk of EOS in extremely preterm (less than 28 weeks gestation) and term (37 weeks or more) infants, but few have analyzed the risk in late and moderately preterm infants (28-36 weeks gestation), despite the fact that these infants make up the bulk of neonatal intensive care unit (NICU) admissions.

Overall, 7,549 infants had a culture taken and were included in the study. Of these, 1,121 (14.8%) were born in a low-risk birth setting and 6,428 (85.2%) were not. A total of 41 infants had confirmed cases of EOS; none of the infected patients were born in a low-risk delivery.

Although no infants born in a low-risk birth setting developed SEO, 80% of them were empirically treated with antibiotics. There was no difference between the low-risk and non-low-risk groups in the proportion of infants who received prolonged antibiotics, suggesting that clinicians did not appreciate or consider the risk of infection more weak and stopped antibiotics in the absence of confirmed infection.

“In the United States, approximately 400,000 uninfected term infants receive empiric antibiotics at birth each year, and more than 90 percent of extremely preterm infants receive antibiotics,” Dr. Flannery said. “Our study shows that a well-defined subset of these infants should not need antibiotics, and clinicians can use delivery characteristics as a guide to prevent unnecessary antibiotic use and avoid potential complications. treatment.”

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Materials provided by Philadelphia Children’s Hospital. Note: Content may be edited for style and length.