Intrapartum antibiotic exposure and early neonatal, morbidity, and mortality in Africa.
BACKGROUND
Infants born to women who receive intrapartum antibiotics may have higher rates of infectious morbidity and mortality than unexposed infants.


OBJECTIVE
Our goal was to determine the association of maternal intrapartum antibiotics and early neonatal morbidity and mortality.


METHODS
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.


RESULTS
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.


CONCLUSIONS
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.
Kafulafula
George
G
Department of Obstetrics and Gynecology, College of Medicine, University of Malawi, Blantyre, Malawi. gkafulafula@jhu.medcol.mw
Mwatha
Anthony
A
Chen
Ying Qing
YQ
Aboud
Said
S
Martinson
Francis
F
Hoffman
Irving
I
Fawzi
Wafaie
W
Read
Jennifer S
JS
Valentine
Megan
M
Mwinga
Kasonde
K
Goldenberg
Robert
R
Taha
Taha E
TE
D000328:Adult; D000349:Africa / Q000453:epidemiology; D000900:Anti-Bacterial Agents / Q000009:adverse effects*; D002821:Chorioamnionitis / Q000188:drug therapy; D005260:Female; D015658:HIV Infections / Q000635:transmission; D006801:Humans; D007223:Infant; D007226:Infant Mortality; D007231:Infant, Newborn; D007232:Infant, Newborn, Diseases / Q000453:epidemiology; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000188:drug therapy; D047928:Premature Birth; D011297:Prenatal Exposure Delayed Effects / Q000453:epidemiology*
D000900:Anti-Bacterial Agents