Study: Infants With Low-Risk Deliveries May Not Need Antibiotics At Birth

New research from the Children’s Hospital of Philadelphia (CHOP) suggests that infants born via uncomplicated cesarean delivery who did not have labor or membrane rupture prior to delivery have a low risk of developing early-onset sepsis and therefore do not need antibiotics.

According to a CHOP press release, the findings could help clinicians tailor the use of early antibiotics in newborns. Only infants deemed at risk for infection should receive antibiotics, thereby reducing unnecessary use, according to the study authors.

“Given the risks associated with early-onset sepsis in infants, it isn’t surprising that newborns are often administered antibiotics immediately after birth,” said first author Dustin D. Flannery, DO, MSCE, an attending neonatologist and clinical researcher at CHOP, in the press release. “However, 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 the potential complications of systemic antibiotic exposure.”

Newborn infants are at risk for early-onset sepsis, which is a life-threatening infection that can occur within 72 hours after birth due to bacteria exposure during birth. However, predicting when infants will develop early-onset sepsis is challenging, which has led to a higher rate of antibiotic use compared to the rate of infants with confirmed infection. Prolonged antibiotic use among newborns has been associated with serious adverse outcomes among preterm infants and potential longstanding complications among full term infants, demonstrating the need for a better way to assess infection risk, according to the study.

The researchers analyzed delivery characteristics to see whether they could help providers identify which infants are at a lower risk of early-onset sepsis. In a retrospective study, they assessed all infants born between 2009 and 2014 at 2 Philadelphia birth hospitals who had a blood or cerebrospinal fluid culture obtained within 72 hours of birth.

The team examined medical record data for confirmed infection and for delivery characteristics, defining a “low-risk” delivery as a cesarean section without rupture of amniotic membranes prior to delivery, without labor or attempts to induce labor, and without suspected or confirmed maternal intraamniotic infection or fetal distress.

The investigators also included infants who were born across the gestational age spectrum. Earlier research has assessed early-onset sepsis risk in both extremely preterm and full-term infants, but few studies have analyzed the risk among late and moderately preterm infants, even though these infants make up the majority of neonatal intensive care unit admissions.

According to the press release, 7549 infants had a culture drawn and were included in the study. Of these, 14.8% were born in a low-risk delivery setting and 85.2% were not. A total of 41 infants had confirmed cases of early-onset sepsis and none of those were born in a low-risk delivery setting.

Although no infants delivered in a low-risk setting developed early-onset sepsis, 80% were empirically treated with antibiotics. There was no difference between the low-risk and non-low-risk groups in the proportion of infants who received prolonged antibiotics, suggesting that clinicians did not account for the lower risk of infection and stop antibiotics in the absence of confirmed infection, according to the study authors.

“In the United States, an estimated 400,000 uninfected term infants receive empirical antibiotics at birth every year, and upwards of 90% of extremely preterm infants receive antibiotics,” Flannery said in the press release. “Our study shows that a well-defined subset of these infants should not need antibiotics, and clinicians can use delivery characteristics as a guide to prevent unnecessary antibiotic use and avoid potential complications of treatment.”

REFERENCE

CCHOP study finds infants with low-risk deliveries should not need antibiotics at birth. News release. Children’s Hospital of Philadelphia; January 13, 2022. Accessed January 13, 2022. https://www.chop.edu/news/chop-study-finds-infants-low-risk-deliveries-should-not-need-antibiotics-birth