Delivery-based criteria for empiric antibiotic administration among preterm infants

J Perinatol. 2021 Feb;41(2):255-262. doi: 10.1038/s41372-020-00784-y. Epub 2020 Aug 13.

Abstract

Objective: Determine impact of using delivery criteria to initiate antibiotics among very low birth weight (VLBW) and extremely low birth weight (ELBW) infants. STUDY DESIGN: Single site cohort study from 01/01/2009 to 01/31/2020. After 04/2017, infants delivered by Cesarean section, without labor or membrane rupture were categorized as low-risk for early-onset infection and managed without empiric antibiotics. We determined effect of this guideline by pre-post, and interrupted time-series analyses.

Results: After 04/2017, antibiotic initiation ≤3 days decreased among low-risk VLBW (62% vs. 13%, p < 0.001) and low-risk ELBW (88% vs. 21%, p < 0.001) infants. In time series analysis, guideline was associated with decreased initiation among low-risk ELBW infants. In contrast, low-risk VLBW infants demonstrated decreased antibiotic initiation throughout study period. Incidence of confirmed infection, death, or transfer ≤7 days age was unchanged.

Conclusion: Delivery criteria may be used to optimize early antibiotic initiation among preterm infants without short-term increase in adverse outcomes.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Anti-Bacterial Agents* / therapeutic use
  • Cesarean Section*
  • Cohort Studies
  • Female
  • Humans
  • Infant
  • Infant, Extremely Low Birth Weight
  • Infant, Newborn
  • Infant, Premature
  • Infant, Very Low Birth Weight
  • Pregnancy

Substances

  • Anti-Bacterial Agents