Received Intrapartum Antibiotics Research Articles

Maternal age and body mass index as risk factors for rectovaginal colonization with group B streptococci.

To examine the effect of including maternal age and body mass index (BMI; calculated as weight in kilograms divided by the square of height in meters) as additional risk factors in the traditional risk-based strategy at term pregnancies consisting of previous early-onset group B streptococcus (GBS) disease, GBS bacteriuria during pregnancy, maternal temperature of 38.0°C or more intrapartum, and rupture of membranes of 18 h or longer. A secondary analysis of a Danish cohort including 902 pregnant women. Exposures were maternal age and pre-pregnancy BMI. Outcome was rectovaginal GBS colonization at the time of labor. The logistic regression analysis adjusted for parity, gestational age, vaginal delivery, and smoking. The GBS prevalence was 17% in the entire population, 35% among participants older than 40 years, and 23% among those with a BMI of 25 or greater. Including maternal "age > 40" as an additional risk factor increased the sensitivity of the risk-based strategy from 21% to 26% and decreased the specificity from 90% to 87%. Inclusion of "BMI ≥ 25" increased the sensitivity from 21% to 57% and decreased the specificity from 90% to 59%. Maternal age and BMI might be included as additional risk factors in risk-based programs for identification of GBS-positive laboring women to receive intrapartum antibiotics prophylaxis.

Does maternal intrapartum antibiotic treatment prolong the incubation time required for blood cultures to become positive for infants with early-onset sepsis?

We hypothesized that maternal intrapartum antibiotic treatment delays the growth of the organism in the blood culture obtained during the work-up for infants with suspected early-onset sepsis (EOS). Single center, retrospective review of infants with blood culture-proven EOS over 13.5 years period. EOS was defined by isolation of a pathogen from blood culture obtained within 72 hours of birth and antibiotic treatment for ≥ 5 days. Among 81 infants with positive blood cultures, 38 were deemed to have EOS and 43 were deemed contaminants. The organisms grown were as follows: Escherichia coli in 17 infants, Group B streptococcus in 10 infants, and others in 11 infants. Overall, 17 infants with EOS did not receive intrapartum antibiotics and had blood cultures drawn for being symptomatic after birth. The other 21 infants who received intrapartum antibiotics had blood culture drawn primarily for maternal chorioamnionitis. The median (interquartile range [IQR]) incubation time to blood culture positivity was not different in infants who received intrapartum antibiotics compared with infants who did not (19.6 hours, IQR 16-28 hours vs. 19.5 hours, IQR 17.2-21.6 hours, p = 0.7489). Maternal intrapartum antibiotic treatment did not delay the time to blood culture positivity in infants with EOS.

Perinatal antibiotic exposure of neonates in Canada and associated risk factors: a population-based study

Objective: To describe neonatal antibiotic exposures occurring immediately before and after birth and their associated risk factors.Methods: A retrospective review of the hospital charts of 449 mother–neonate pairs enrolled in the Canadian Healthy Infant Longitudinal Development national birth-cohort study was conducted at two tertiary hospitals and one rural hospital in Manitoba, Canada. The main outcome measures included the following: maternal and neonatal antibiotic use during the perinatal period; indications for antibiotic use, including suspected neonatal sepsis, maternal group B Streptococcus (GBS), premature rupture of membranes and caesarean-section; maternal health status, focusing on gestational hypertension, gestational diabetes, obesity and primigravida pregnancies.Results: During the perinatal period, 45.0% of neonates were exposed to antibiotics. Intravenous penicillin G (17%) and cefazolin (16%) were the most commonly administered intrapartum antibiotics. Colonization with GBS was confirmed in 21.2% of women and treated with antibiotics in 86% of cases. Overweight women and women with hypertension were significantly more likely to receive intrapartum antibiotics for caesarean section or GBS prophylaxis. Antibiotic treatment of the neonate was highest following emergency caesarean section (12%) or unknown maternal GBS status (20%).Conclusions: Neonates in Canada are routinely exposed to antibiotics during the perinatal period.

PLD.52 Management and outcome of patients with Pre-labour Spontaneous rupture of membranes

StudyRetrospective, during September–October 2010.Patients90 patients, in a District General Hospital.AimTo look at the management and outcome of Pre-labour Spontaneous Rupture Of Membranes (SROM).ResultsWe looked at the method of confirmation of...

1167 Does Maternal Intrapartum Antibiotics Prolong the Incubation Time Required for Blood Cultures to Become Positive for Infants with Early-Onset Sepsis?

We hypothesize that maternal intrapartum antibiotic treatment delays the growth of organism in the blood culture obtained during the workup for infants with suspected early-onset sepsis (EOS). The aim is...

1189 Missed Opportunities for Prevention of Early Onset Group B Streptococcus (EOGBS) Infection in Northern Ireland

Background and AimsEOGBS infection is associated with high morbidity and mortality. Historically N. Ireland has had a higher incidence than other parts of the UK. The incidence can be reduced...

Intrapartum antibiotic exposure and early neonatal, morbidity, and mortality in Africa.

Infants born to women who receive intrapartum antibiotics may have higher rates of infectious morbidity and mortality than unexposed infants. Our goal was to determine the association of maternal intrapartum antibiotics and early neonatal morbidity and mortality. We performed secondary analysis of data from a multisite randomized, placebo-controlled clinical trial of antibiotics to prevent chorioamnionitis-associated mother-to-child transmission of HIV-1 and preterm birth in sub-Saharan Africa. Early neonatal morbidity and mortality were analyzed. In an intention-to-treat (ITT) analysis, infants born to women randomly assigned to antibiotics or placebo were compared. In addition, non-ITT analysis was performed because some women received nonstudy antibiotics for various clinical indications. Overall, 2659 pregnant women were randomly assigned. Of these, 2466 HIV-1-infected and HIV-1-uninfected women delivered 2413 live born and 84 stillborn infants. In the ITT analysis, there were no significant associations between exposure to antibiotics and early neonatal outcomes. Non-ITT analyses showed more illness at birth (11.2% vs 8.6%, P = .03) and more admissions to the special care infant unit (12.6% vs 9.8%, P = .04) among infants exposed to maternal intrapartum antibiotics than among unexposed infants. Additional analyses revealed greater early neonatal morbidity and mortality among infants of mothers who received nonstudy antibiotics than of mothers who received study antibiotics. There is no association between intrapartum exposure to antibiotics and early neonatal morbidity or mortality. The associations observed in non-ITT analyses are most likely the result of women with peripartum illnesses being more likely to receive nonstudy antibiotics.

Early-onset neonatal group B streptococcal sepsis: intrapartum antibiotic prophylaxis in the clinical setting.

To evaluate how guidelines for the use of intrapartum antibiotics for the prevention of early-onset Group B streptococcal infection are utilized in a clinical setting. Review of maternal/infant records for the year 1993 in a perinatal center. Intrapartum antibiotics were administered to 77.8% of 443 Group B streptococcus (GBS)-colonized women. There were 452 infants born to these mothers, of which four developed GBS infection. During the same period, an additional 11 infants with GBS infection were born to women with "negative" or "unknown" GBS status (the women did not receive intrapartum antibiotics). Infants of GBS-colonized women who had not receive antibiotics were more likely to develop infection than GBS negative or unknown status, odds ratio 9.0, 95% confidence interval (2.8-29.1). This study supports the use of intrapartum antibiotics as an important means of preventing early-onset neonatal GBS infection but demonstrates problems that may be encountered in the clinical application of guidelines for intrapartum antibiotic prophylaxis.

Neonatal sepsis workups in infants >/=2000 grams at birth: A population-based study.

Few data are available on the outcome of neonatal sepsis evaluations in an era when intrapartum antibiotic therapy is common. We identified all newborns weighing >/=2000 g at birth who were ever evaluated for suspected bacterial infection at 6 Kaiser Permanente hospitals between October 1995 and November 1996, reviewed their records and laboratory data, and tracked them to 1 week after discharge. We analyzed the relationship between key predictors and the presence of neonatal bacterial infection. Among 18 299 newborns >/=2000 g without major congenital anomalies, 2785 (15.2%) were evaluated for sepsis with a complete blood count and/or blood culture. A total of 62 (2.2%) met criteria for proven, probable, or possible bacterial infection: 22 (.8%) had positive cultures and 40 (1.4%) had clinical evidence of bacterial infection. We tracked all but 10 infants (.4%) to 7 days postdischarge. There were 67 rehospitalizations (2.4%; 2 for group B streptococcus bacteremia). Among 1568 infants who did not receive intrapartum antibiotics, initial asymptomatic status was associated with decreased risk of infection (adjusted odds ratio [AOR]:.26; 95% confidence interval [CI]:.11-.63), while chorioamnionitis (AOR: 2. 40; 95% CI: 1.15-5.00), low absolute neutrophil count (AOR: 2.84; 95% CI: 1.50-5.38), and meconium-stained amniotic fluid (AOR: 2.23; 95% CI: 1.18-4.21) were associated with increased risk. Results were similar among 1217 infants who were treated, except that maternal chorioamnionitis was not significantly associated with neonatal infection. The risk of bacterial infection in asymptomatic newborns is low. Evidence-based observation and treatment protocols could be defined based on a limited set of predictors: maternal fever, chorioamnionitis, initial neonatal examination, and absolute neutrophil count. Many missed opportunities for treating mothers and infants exist.

Preventing neonatal group B streptococcal disease: cost-effectiveness in a health maintenance organization and the impact of delayed hospital discharge for newborns who received intrapartum antibiotics.

To estimate the cost and health benefits of implementing a risk factor-based prevention strategy for early-onset neonatal group B streptococcal (GBS) disease, using baseline assumptions and costs from a health maintenance organization. With the risk factor-based strategy, intrapartum antibiotics (IPAs) would be provided to women with fever, prolonged rupture of membranes, or preterm labor. A second objective was to determine the impact of an increased length of stay for well term infants with mothers who received IPAs. We used decision analysis to compare the costs and benefits of the prevention strategy with usual obstetric practice for a cohort of 100 000 women and their newborn infants. We derived baseline values from a previous study based on chart review and automated cost data from a health maintenance organization in Northern California. In sensitivity analyses, we varied baseline assumptions, including additional costs for observing well term infants who received IPAs. If adherence to guidelines were 100%, 17% of mothers would receive IPAs at a cost of $490,000; $1.6 million would be saved by preventing 66 GBS cases (64% reduction). The net savings would be $1.1 million and 61 life-years. The net cost is sensitive to the cost of caring for well infants who received IPAs. If each term infant of a mother who received IPAs had 1 more day of observation than other term infants, there would be a net cost of $8.1 million; the cost per GBS case prevented would be $120,000 and the cost per life-year saved would be $130,000. Implementation in a health maintenance organization of a risk factor-based strategy to prevent neonatal GBS disease can prevent substantial disease and be cost saving. However, if the length of hospital stay were extended among well term infants whose mothers received IPAs, the strategy would be relatively costly compared with other medical interventions.

Outcome of Term Gestation Neonates Whose Mothers Received Intrapartum Antibiotics for Suspected Chorioamnionitis

Intrapartum antibiotics are commonly given to women suspected of having chorioamnionitis. However, there is no consensus regarding management of their babies. To date, there are no data concerning the clinical courses and outcomes of term gestation, pretreated neonates. We performed a retrospective review to assess the clinical courses of such infants. From 1987 to 1989, chorioamnionitis was diagnosed in 123 women, 102 of whom received intrapartum antibiotics. Of the 86 term gestation infants born to women in the latter group, 63 were completely asymptomatic. When compared with these neonates, the 23 symptomatic infants were more likely to have lower median 1 and 5 minute Apgar scores (3 vs 8 and 7 vs 9, respectively; p < 0.0001), higher immature:mature neutrophil ratios on their initial complete blood counts (0.48 vs 0.24; p = 0.0003), and positive urine antigen studies for group B Streptococcus in the presence of negative blood cultures (4 vs 2; p = 0.042). The intrapartum courses of those infants destined to be symptomatic were more likely to be complicated by fetal tachycardia (p = 0.049) and malodorous amniotic fluid (p = 0.005). Since more than 95% of asymptomatic, pretreated, term gestation neonates have a benign clinical course, aggressive evaluation and management of these infants may not be necessary.

Outcome of Term Gestation Neonates Whose Mothers Received Intrapartum Antibiotics for Suspected Chorioamnionitis

Intrapartum antibiotics are commonly given to women suspected of having chorioamnionitis. However, there is no consensus regarding management of their babies. To date, there are no data concerning the clinical courses and outcomes of term gestation, "pretreated" neonates. We performed a retrospective review to assess the clinical courses of such infants. From 1987 to 1989, chorioamnionitis was diagnosed in 123 women, 102 of whom received intrapartum antibiotics. Of the 86 term gestation infants born to women in the latter group, 63 were completely asymptomatic. When compared with these neonates, the 23 symptomatic infants were more likely to have lower median 1 and 5 minute Apgar scores (3 vs 8 and 7 vs 9, respectively; p < 0.0001), higher immature:mature neutrophil ratios on their initial complete blood counts (0.48 vs 0.24; p = 0.0003), and positive urine antigen studies for group B Streptococcus in the presence of negative blood cultures (4 vs 2; p = 0.042). The intrapartum courses of those infants destined to be symptomatic were more likely to be complicated by fetal tachycardia (p = 0.049) and malodorous amniotic fluid (p = 0.005). Since more than 95% of asymptomatic, pretreated, term gestation neonates have a benign clinical course, aggressive evaluation and management of these infants may not be necessary.