Impact of intrapartum antibiotics on the care and evaluation of the neonate

Abstract

Despite concerns that IAP guidelines would result in excessive neonatal evaluations, infants sampled whose mothers received IAP were not more likely to undergo invasive procedures or to receive antibiotics. Consistent with the guidelines, collection of complete blood counts was more common among such infants.

Cost-Effectiveness of Universal Prophylaxis in Pregnancy with Prior Group B Streptococci Colonization

“…In 1999, federal legislation required insurers to cover up to 48 hours of hospitalization after a vaginal delivery [44]. Studies comparing the length of stay for infants delivering vaginally whose mother received intrapartum antibiotics for GBS prophylaxis compared with those who did not, demonstrated no significant difference [6, 23]. Since 2000, length of stay for women delivering vaginally and their “well infants” has averaged 2.1 days [45].…”

“…A full diagnostic evaluation and empiric therapy is initiated only if sepsis is suspected. Although the algorithm recommends that only neonates with symptoms of sepsis undergo a diagnostic workup, clinicians are more likely to pursue diagnostic testing if the mother received prophylactic intrapartum antibiotics, regardless of the infant's signs and symptoms [23]. Practitioners managing newborns noted that among infants with no signs of sepsis, 20% of neonates whose mothers received intrapartum antibiotics had a CBC, compared with 4% of neonates whose mothers did not receive intrapartum antibiotics [23].…”

“…Although the algorithm recommends that only neonates with symptoms of sepsis undergo a diagnostic workup, clinicians are more likely to pursue diagnostic testing if the mother received prophylactic intrapartum antibiotics, regardless of the infant's signs and symptoms [23]. Practitioners managing newborns noted that among infants with no signs of sepsis, 20% of neonates whose mothers received intrapartum antibiotics had a CBC, compared with 4% of neonates whose mothers did not receive intrapartum antibiotics [23]. Further, only 4% of infants born to mothers who received intrapartum antibiotics, regardless of whether it was less or greater than 4 hours before delivery, had blood cultures [23].…”

“…Practitioners managing newborns noted that among infants with no signs of sepsis, 20% of neonates whose mothers received intrapartum antibiotics had a CBC, compared with 4% of neonates whose mothers did not receive intrapartum antibiotics [23]. Further, only 4% of infants born to mothers who received intrapartum antibiotics, regardless of whether it was less or greater than 4 hours before delivery, had blood cultures [23]. Since studies suggest that a limited diagnostic workup varies regardless of whether a mother received <4 hours of intrapartum antibiotics, we estimated a midpoint of this range (4% to 100%) or a probability of 0.52 that both a CBC and blood culture would be obtained [1, 6, 23].…”

“…Further, only 4% of infants born to mothers who received intrapartum antibiotics, regardless of whether it was less or greater than 4 hours before delivery, had blood cultures [23]. Since studies suggest that a limited diagnostic workup varies regardless of whether a mother received <4 hours of intrapartum antibiotics, we estimated a midpoint of this range (4% to 100%) or a probability of 0.52 that both a CBC and blood culture would be obtained [1, 6, 23]. If >4 hours of intrapartum antibiotics were received, we assumed that no additional diagnostic evaluation would be performed except for the usual 48 hours of newborn observation.…”