No antibiotics in infants born in low risk delivery, study finds

Washington US January 16, ANI A team of international researchers have found that infants born through uncomplicated caesarean delivery, without labor or membrane rupture before delivery and no concern for infection, should not need antibiotics at birth.

According to first author Dustin D. Flannery, DO, MSCE, an attending neonatologist and clinical researcher at Children's Hospital of Philadelphia, it isn't surprising that newborns are often given antibiotics immediately after birth, because of the risks associated with early-onset sepsis in infants.

Our study shows that it is safe to withhold antibiotics in infants, including those born preterm, with low risk delivery characteristics. Such infants are unlikely to be infected at birth, and can be spared from the potential complications of systemic antibiotic exposure, he added.

Newborn infants are at risk for early-onset sepsis EOS, a life-threatening infection that can occur within 72 hours after birth due to exposure to bacteria during the birth process. Predicting which infants will develop EOS is challenging.

This has resulted in an order of magnitude higher rate of antibiotic use compared to the rate of infants with confirmed infection. Prolonged antibiotic use among newborns is associated with serious adverse outcomes for preterm infants and potentially long-term complications among full-term infants, underscoring the need for a better way to assess infection risk.

The researchers wanted to find out if infants are at the lowest risk of EOS because of the primary way a newborn is exposed to bacteria through the delivery process. In a retrospective study, they assessed infants born at two Philadelphia birth hospitals in 2009 and 2014 who had blood or cerebrospinal fluid culture within 72 hours of birth.

They looked at medical record data for confirmed infection and delivery characteristics, defining a low-risk delivery as a caesarean section without rupture of amniotic membranes prior to delivery, an absence of labor or attempts to induce labour, and an absence of suspected or confirmed maternal intraamniotic infection or foetal distress.

The researchers included infants born across the gestational age spectrum. Prior studies have evaluated EOS risk in both extremely preterm less than 28 weeks gestation and full-term 37 weeks or more infants, but few have examined the risk among late and moderately preterm infants 28 -- 36 weeks gestation despite the fact that these infants make up the bulk of neonatal intensive care unit NICU admissions.

In total, 7,549 infants had a culture drawn and included in the study. 1,121 14.8 per cent were born in a low-risk delivery setting and 6,428 85.2 per cent were not. A total of 41 infants had confirmed cases of EOS; none of the infected patients were born in the setting of a low-risk delivery.

Even though no infants in a low-risk delivery setting developed EOS, 80 per cent of them were empirically treated with antibiotics. There was no difference between the low risk and non-low risk groups in the proportion of infants receiving prolonged antibiotics, suggesting that clinicians did not account for the lower risk of infection and stopped antibiotics in the absence of confirmed infection.

In the United States, an estimated 400,000 uninfected term infants receive empirical antibiotics every year, and upwards of 90 per cent of extremely preterm infants receive antibiotics, Dr Flannery said.