Antibiotic Therapy for Reduction of Infant Morbidity After Preterm Premature Rupture of the Membranes

Mercer, Brian M.; Miodovnik, Menachem; Thurnau, Gary R.; Goldenberg, Robert L.; Das, Anita; Ramsey, Risa; Rabello, Yolanda A.; Meis, Paul J.; Moawad, Atef H.; Iams, Jay D.; Dorsten, J. Peter Van; Paul, Richard H.; Merenstein, Gerald B.; Thom, Elizabeth; Roberts, James M.; McNellis, Donald

doi:10.1097/00006254-199805000-00002

Cited by 19 publications

(29 citation statements)

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“…The ORACLE trials suggested an association between administration of oral amoxicillin/clavulanate to women with PPROM or spontaneous PTL and the subsequent development of NEC in their infants. 21,22 In contrast, in a casecontrol chart review spanning a 17-year study period, Al-Sabbagh et al 23 found no evidence of an association betweeen antenatal exposure to amoxicilllin/clavulanate and the later development of 19,27 however, showed that aggressive antenatal antibiotic treatment was associated with a reduction in NEC. Why might antepartum antibiotic exposure set the stage for NEC weeks later?…”

Section: Discussionmentioning

confidence: 96%

“…Throughout this period, though, ampicillin has been widely used, alone and in combination with sulbactam or erythromycin, in the management of PPROM and clinical chorioamnionitis and as an alternative to penicillin for group B streptococcal chemoprophylaxis. [18][19][20] Given the widespread use of ampicillin in these clinical contexts, the association of antepartum ampicillin exposure with NEC is of great concern.…”

Section: Discussionmentioning

confidence: 99%

“…9,14 -17 Maternal antibiotic administration as part of the antenatal management of pregnancy complications that result in preterm birth, including unexplained preterm labor (PTL), preterm premature rupture of membranes (PPROM) and clinical chorioamnionitis, is a common clinical practice. [18][19][20] There is no consensus in the literature regarding the risk of NEC associated with antenatal maternal antibiotic administration. Two reports suggest an association between antenatal exposure to oral amoxicillin/clavulanate and the subsequent development of NEC.…”

Section: Introductionmentioning

confidence: 99%

“…21,22 Other investigators have not found such an association, or have found an association between antenatal antibiotic administration and reduced incidence of NEC. 19,23,24 We performed a retrospective, case-controlled study of newborns with NEC born at our institution between 1988 and 2006 to test the hypothesis that antenatal antibiotic exposure is associated with a greater risk of NEC.…”

Section: Introductionmentioning

confidence: 99%

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Antenatal antibiotic exposure in preterm infants with necrotizing enterocolitis

Ferrara

DeLuca

et al. 2011

J Perinatol

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Objective: To determine whether an association exists between antenatal antibiotic exposure and incidence of necrotizing enterocolitis (NEC) in low birth weight infants.Study Design: A retrospective case-control study was performed on all infants with a diagnosis of NEC born at our institition between 1988 and 2006. Medical histories of all infants with a diagnosis of NEC XBell's stage IIA and matched controls without NEC were reviewed. Maternal and neonatal characteristics were compared using the Mantel-Haenszel chi-square procedure, and logistic regression models were constructed to account for confounding.Result: Clinical data for 97 matched pairs were analyzed. The adjusted odds ratio (OR) for antenatal exposure to ampicillin was significantly greater for infants who developed NEC (OR 2.3, 95% confidence interval 1.1, 4.8, P ¼ 0.003) than for control infants. Conclusion:Infants who developed NEC were more likely to have a history of in utero exposure to ampicillin in the immediate antepartum period than infants who did not develop NEC.

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Section: Discussionmentioning

confidence: 96%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Antenatal antibiotic exposure in preterm infants with necrotizing enterocolitis

Ferrara

DeLuca

et al. 2011

J Perinatol

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“…To reduce the risk of complications such as respiratory distress syndrome, intraventricular hemorrhage and mortality of the preterm neonate antenatal administration of corticoid drugs is widely used 3,5,6 . To prevent maternal and fetal infections, antibiotics are used in patients with pPROM 3,[5][6][7][8] . Nonetheless, infections are frequent in mother and child 3,[5][6][7][8] .…”

mentioning

confidence: 99%

Impaired Whole‐Blood Polymorphonuclear Leukocyte Migration as a Possible Predictive Marker for Infections in Preterm Premature Rupture of Membranes

Glasner

Egger

Winter

2000

Infectious Diseases in Obstetrics and Gynecology

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Objectives: Steroids, used in preterm premature rupture of membranes (pPROM), to reduce the risk of morbidity and mortality of the preterm neonate, impair the maternal polymorphonuclear leukocyte (PMN)-based immune system. In spite of combination with antibiotics, prenatal and postnatal bacterial infections of mother and child are frequent. This pilot study focuses on the influence of steroids in pPROM on maternal PMN functional capacity and subsequent infections. Methods: After opting for expectant management, eight women with pPROM and no signs of infection were treated by steroids (betamethasone 5.7 mg, i.m. every 24 hours, for three days) and antibiotic therapy with either amoxicillin and clavulanic acid, piperacillin or ampicillin i.v. up to delivery. The conventional inflammation parameters of PMN blood count and C-reactive protein (CRP) were measured daily in parallel with PMN migratory capacity towards N-formyl-methionyl-leucyI-phenylalanine stimulation and under blank conditions, estimated by a whole blood membrane filter assay. Results: In all patients PMN migration decreased during the application of steroids. Three patients showed a decrease in PMN migration below critical values and in spite of antibiotic prophylaxis acute pyelonephritis developed 2-6 days later. PMN count and CRP were not predictive of maternal infection. Conclusion: Reduced PMN function, caused by steroid treatment in pPROM, is suggested to be a reason for serious bacterial infections in spite of antibiotic prophylaxis. PMN migration reflects individual PMN defensive capacity.

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Fetal Membrane Histology in Preterm Premature Rupture of Membranes: Comparison to Controls, and between Antibiotic and Placebo Treatment

et al. 1999

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The objectives of this study were to test the hypotheses that antibiotic therapy will alter the histologic appearance of fetal membranes in preterm premature rupture of membranes (pPROM), and that the membrane histology will demonstrate distinct differences between term and preterm rupture of membranes. We also wished to test interobserver variability of pathologists. Placental membranes were sampled from 268 women participating in a randomized placebo-controlled trial of antibiotic therapy for pPROM at 24-32 weeks of gestation (cases) and from 4 control groups who were not in the randomized trial: (1) preterm labor without pPROM (n = 21), (2) term labor (n = 65), (3) term PROM (n = 21), and (4) term cesarean section (n = 27). The cases and controls were scored for 40 histologic features by pathologists blinded to the identity of each sample (case or control). pPROM histology of samples from patients receiving antibiotics and those receiving placebo was compared using a chi-squared test and with control groups using logistic regression. There were no histological differences between pPROM cases treated with antibiotic and those receiving placebo, nor with respect to duration of membrane rupture greater or less than 48 h. Concordance among pathologists was low for features other than acute inflammation. Logistic regression analysis controlled for race and pathologist, and demonstrated that all of the control groups had significantly fewer common markers of acute inflammation when compared with the pPROM cases. This study suggests that histopathologic evidence of infection is seen more frequently with pPROM than in preterm or term controls. The histologic features used in this study cannot be used to determine the effectiveness of antibiotic therapy.

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Antibiotic Therapy for Reduction of Infant Morbidity After Preterm Premature Rupture of the Membranes

Cited by 19 publications

References 0 publications

Antenatal antibiotic exposure in preterm infants with necrotizing enterocolitis

Antenatal antibiotic exposure in preterm infants with necrotizing enterocolitis

Impaired Whole‐Blood Polymorphonuclear Leukocyte Migration as a Possible Predictive Marker for Infections in Preterm Premature Rupture of Membranes

Fetal Membrane Histology in Preterm Premature Rupture of Membranes: Comparison to Controls, and between Antibiotic and Placebo Treatment

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