Latency antibiotics in preterm premature rupture of membranes: Are they still indicated?

Abstract

THEY STILL INDICATED? EVA PRESSMAN, CARLA KOVACS, University of Rochester, Obstetrics and Gynecology, Rochester, New York OBJECTIVE: Prior studies have indicated that antibiotics for the prolongation of latency in patients with preterm premature rupture of membranes (PPROM) lead to improved neonatal outcomes. These studies were done prior to widespread use of tocolytics, antenatal steroids andGroupB streptococcus (GBS)prophylaxis in patientswithPPROM.The purpose of our study is todeterminewhether the use of latency antibiotics improves outcomes in current obstetrical practice. STUDY DESIGN: We performed a retrospective cohort analysis of subjects with PPROM at 18 to 34 weeks from 2002 to 2006. Use of latency antibiotics for PPROM became common in 2004 at our institution. Data were collected on gestational age (GA) at PPROM and the use of latency antibiotics, tocolytics, GBS prophylaxis, and steroids. Primary outcomes were latency until delivery and NICU length of stay (LOS). Secondary outcomes included chorioamnionitis, neonatal sepsis, necrotizing enterocolitis, respiratory distress syndrome, intraventricular hemorrhage and neonatal death. Continuous data were analyzed with t-tests and categorical data with Chi square. RESULTS: We identified 207 subjects; 69 received latency antibiotics and 138 did not. The groups were similar with respect to GA at PPROM (29.4 vs 30.2 wks) and administration of tocolytics (74% vs 71%), GBS prophylaxis (84% vs 89%) and steroids (81% vs 73%), pO0.05 for all. We found no differences in either latency (15.3 vs 15.7 days, p=0.93) or NICU LOS (26.2 vs 30.6 days, p=0.27), or in any of the secondary outcomes. Post hoc power analysis revealed 93% power to detect a 7 day difference in latency and 81% power to detect a 7 day difference in NICU LOS. CONCLUSION: Unlike prior studies, we did not find prolonged latency or improved neonatal outcome in PPROM subjects who received latency antibiotics. Our population differs from prior study populations in the routine use of antenatal steroids, tocolytics and antibiotics for GBS prophylaxis. Our findings draw into question the need for latency antibiotics in PPROM patients who are receiving these therapies.