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Role of prophylactic antibiotics in neonates born through meconium-stained amniotic fluid (MSAF)—a randomized controlled trial

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Abstract

The objective of the study was to evaluate the effect of administering prophylactic antibiotics on the development of neonatal sepsis in term neonates born through meconium-stained amniotic fluid (MSAF). Two hundred and fifty eligible neonates were randomized to study group (Antibiotic group—receiving first-line antibiotics for 3 days) and control group (No Antibiotic group). Both groups were evaluated clinically and by laboratory parameters (sepsis screen and blood cultures) for development of sepsis. All neonates were monitored for respiratory, neurological, and other systemic complications and received supportive treatment according to standard management protocol of the unit. One hundred and twenty one neonates were randomized to ‘Antibiotic’ group and 129 to ‘No Antibiotic’ group. The overall incidence of suspect sepsis was 9.6 % in the study population with no significant difference between ‘No Antibiotic’ and ‘Antibiotic’ groups (10.8 vs. 8.2 %, p = 0.48, odds ratio (OR) 0.74, 95 % confidence interval (CI) 0.32–1.73). Incidence of culture-proven sepsis was also not significantly different between the two groups (5.42 vs. 4.13 %, p = 0.63, OR 0.75, 95 % CI 0.23–2.43). The incidence of mortality, meconium aspiration syndrome, and other complications was comparable amongst the two groups. Conclusion: Routine antibiotic prophylaxis in neonates born through MSAF did not reduce the incidence of sepsis in this study population. (Clinicaltrials.gov no. - NCT01290003)

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Abbreviations

HIE:

Hypoxic ischemic encephalopathy

MSAF:

Meconium-stained amniotic fluid

MAS:

Meconium aspiration syndrome

PPHN:

Persistent pulmonary hypertension of newborn

UTI:

Urinary tract infection

References

  1. Cleary GM, Wiswell TE (1998) Meconium-stained amniotic fluid and the meconium aspiration syndrome: an update. Pediatr Clin North Am 45:511–529

    Article  CAS  PubMed  Google Scholar 

  2. Wiswell TE (2001) Advances in the treatment of the meconium aspiration syndrome. Acta Paediatr 90(Suppl):28–30

    Article  CAS  Google Scholar 

  3. Wiswell TE, Tuggle JM, Turner BS (1990) Meconium aspiration syndrome: have we made a difference? Pediatrics 85:715–721

    CAS  PubMed  Google Scholar 

  4. Blot P, Milliez J, Breart G, Vige P, Nessmann C, Onufryk JP, Dendrinos S, Sureau C (1983) Fetal tachycardia and meconium staining—a sign of fetal infection. Int J Gynecol Obstet 21:189–194

    Article  CAS  Google Scholar 

  5. Bryan CS (1967) Enhancement of bacterial infections by meconium. Johns Hopkins Med J 121:9–13

    Google Scholar 

  6. Florman AL, Teubner D (1969) Enhancement of bacterial growth in amniotic fluid by meconium. J Pediat 74:111–114

    Article  CAS  PubMed  Google Scholar 

  7. Romero R, Hanaoka S, Mazor M, Athanassiadis AP, Callahan R, Hsu YC, Avila C, Nores J, Jimenez C (1991) Meconium-stained amniotic fluid: a risk factor for microbial invasion of the amniotic cavity. Am J Obstet Gynecol 164:859–862

    Article  CAS  PubMed  Google Scholar 

  8. Craig S, Lopez A, Hoskin D, Markham F (2005) Meconium inhibits phagocytosis and stimulates respiratory burst in alveolar macrophages. Pediatr Res 57(6):813–818

    Article  CAS  PubMed  Google Scholar 

  9. Basu S, Kumar A, Bhatia BD (2007) Role of antibiotics in meconium aspiration syndrome. Ann Trop Pediatr 27:107–113

    Article  Google Scholar 

  10. Lin HC, Su BH, Tsai CH, Lin TW, Yeh TF (2005) Role of antibiotics in management of non-ventilated cases of meconium aspiration syndrome without risk factors for infection. Biol Neonate 87:51–58

    Article  PubMed  Google Scholar 

  11. Shankar V, Paul VK, Deorari AK, Singh M (1995) Do neonates with meconium aspiration syndrome require antibiotics? Indian J Pediatr 62:327–331

  12. Wiswell TE, Henley MA (1992) Intratracheal suctioning, systemic infection and the meconium aspiration syndrome. Pediatrics 89:203–207

    CAS  PubMed  Google Scholar 

  13. Eidelman AI, Nevet A, Rudensky B, Rabinowitz R, Hammerman C, Raveh D, Schimmel MS (2002) The effect of meconium staining of amniotic fluid on the growth of Escherichia coli and group B streptococcus. J Perinatol 22:467–471

    Article  PubMed  Google Scholar 

  14. Schimmel M, Eidelman A, Rudensk B (1996) Meconium stained amniotic fluid and bacterial growth a quantitative study. Pediatr Res 39(4):301–301

    Article  Google Scholar 

  15. Lee JS, Stark AR (2008) Meconium aspiration. In: Cloherty JP, Eichenwald EC, Stark AR (eds) Manual of neonatal care, 6th edn. Lippincott Williams and Wilkins, Philadelphia, pp 383–387

    Google Scholar 

  16. Singh BS, Clark RH, Powers RJ, Spitzer AR (2009) Meconium aspiration syndrome remains a significant problem in the NICU: outcomes and treatment patterns in term neonates admitted for intensive care during a ten year period. J Perinatol 29:497–503

    Article  CAS  PubMed  Google Scholar 

  17. Krishnan L, Prabhakar P, Bhaskaranand N (1995) Routine antibiotic cover for newborns intubated for aspirating meconium: is it necessary? Indian Pediatr 32(5):529–531

    CAS  PubMed  Google Scholar 

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This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.

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Authors and Affiliations

  1. Department of Pediatrics, Lady Hardinge Medical College and Kalawati Saran Children Hospital, New Delhi, India

    Ankita Goel, Sushma Nangia, Arvind Saili & Akanksha Garg

  2. Department of Pathology, Lady Hardinge Medical College, New Delhi, India

    Sunita Sharma

  3. Department of Microbiology, Lady Hardinge Medical College, New Delhi, India

    V. S. Randhawa

Authors
  1. Ankita Goel
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  2. Sushma Nangia
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  3. Arvind Saili
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  4. Akanksha Garg
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  5. Sunita Sharma
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  6. V. S. Randhawa
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Corresponding author

Correspondence to Sushma Nangia.

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Communicated by Patrick Van Reempts

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Goel, A., Nangia, S., Saili, A. et al. Role of prophylactic antibiotics in neonates born through meconium-stained amniotic fluid (MSAF)—a randomized controlled trial. Eur J Pediatr 174, 237–243 (2015). https://doi.org/10.1007/s00431-014-2385-4

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  • DOI: https://doi.org/10.1007/s00431-014-2385-4

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