Impact of intrapartum antibiotics on the care and evaluation of the neonate.
BACKGROUND
Management of infants whose mothers receive intrapartum antibiotic prophylaxis (IAP) is controversial. In 1996 consensus guidelines for prevention of neonatal Group B streptococcal disease included an algorithm for management of infants whose mothers received IAP. To assess practices for testing and treatment of infants, we evaluated a population-based sample of deliveries to see whether excessive evaluation and treatment occurs after IAP.


METHODS
Medical records for 869 deliveries in Connecticut during 1996 were sampled. IAP was administered in 96 full term deliveries. We excluded infants <37 weeks and those with intrapartum fever. We reviewed hospital records for infants born after IAP (n = 81) and a random sample of those not exposed (n = 180). Analyses were conducted with sample weights to account for unequal probability of selection.


RESULTS
Infants whose mothers received IAP were more likely to have complete blood counts, (26% vs. 9% P = 0.05) but were no more likely to receive antibiotics in the first week of life (P = 0.48), have an intravenous catheter placed (P = 0.83), or to have other invasive procedures. Mean length of hospital stay was 6 h longer for infants born by vaginal delivery to mothers who had IAP (47.0 h) than for those without IAP (41.3 h) (P = 0.06).


CONCLUSIONS
Despite concerns that IAP guidelines would result in excessive neonatal evaluations, infants sampled whose mothers received IAP were not more likely to undergo invasive procedures or to receive antibiotics. Consistent with the guidelines, collection of complete blood counts was more common among such infants.
Balter
Sharon
S
Respiratory Diseases Branch, Centers for Disease Control and Prevention, Atlanta, GA, USA.
Zell
Elizabeth R
ER
O'Brien
Katherine L
KL
Roome
Aaron
A
Noga
Heather
H
Thayu
Meena
M
Schuchat
Anne
A
D000328:Adult; D000465:Algorithms; D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D019072:Antibiotic Prophylaxis; D016470:Bacteremia / Q000517:prevention & control*; D001772:Blood Cell Count; D016022:Case-Control Studies; D004334:Drug Administration Schedule; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007231:Infant, Newborn; D007232:Infant, Newborn, Diseases / Q000175:diagnosis*; D007743:Labor, Obstetric; D008297:Male; D011247:Pregnancy; D011336:Probability; D012016:Reference Values; D018570:Risk Assessment; D012494:Sampling Studies; D013290:Streptococcal Infections / Q000517:prevention & control*; D013292:Streptococcus agalactiae / Q000187:drug effects*; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents