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

Abstract

Management of infants whose mothers receive intrapartum antibiotic prophylaxis (IAP) is controversial. In 1996 consensus guidelines for prevention of neonatal Group B streptococcal disease included an algorithm for management of infants whose mothers received IAP. To assess practices for testing and treatment of infants, we evaluated a population-based sample of deliveries to see whether excessive evaluation and treatment occurs after IAP. Medical records for 869 deliveries in Connecticut during 1996 were sampled. IAP was administered in 96 full term deliveries. We excluded infants <37 weeks and those with intrapartum fever. We reviewed hospital records for infants born after IAP (n = 81) and a random sample of those not exposed (n = 180). Analyses were conducted with sample weights to account for unequal probability of selection. Infants whose mothers received IAP were more likely to have complete blood counts, (26% vs. 9% P = 0.05) but were no more likely to receive antibiotics in the first week of life (P = 0.48), have an intravenous catheter placed (P = 0.83), or to have other invasive procedures. Mean length of hospital stay was 6 h longer for infants born by vaginal delivery to mothers who had IAP (47.0 h) than for those without IAP (41.3 h) (P = 0.06). 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.