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    • Overall we found maternal antibiotics to

    2023-05-29

    Overall, we found maternal igf1r inhibitor to be associated with improved outcomes. In these multiple logistic regression models, high postnatal empiric infant antibiotic exposure was not significantly associated with risk for NEC or LOS. However, consistent with previous studies,5, 6 receipt of high empiric infant antibiotics was associated with a significantly increased risk of death (OR 3.18, P = .002). The combined outcome of NEC, LOS, or death was not significantly different in infants with high empiric antibiotic exposure (OR 1.44, P = .17). We then examined the combination of maternal antibiotic exposure and high-empiric infant antibiotics. In infants who later received low-empiric antibiotics, maternal antibiotic exposure remained protective for NEC (OR = 0.24, P = .001). Maternal antibiotics in combination with high infant antibiotics were not significantly associated with a reduction in NEC (OR = 0.36, P = .09). Maternal antibiotic exposure was not a risk factor for the development of LOS in the high or low infant antibiotic groups (OR 1.06, P = .9 and OR 2.13, P = .07, respectively). Similar to NEC, receipt of maternal antibiotics was protective for death in the high (OR 0.33, P = .048) and for death and NSD in low (OR 0.19, P = .003 and OR 0.53, P = .04) infant postnatal antibiotic receipt groups. Maternal antibiotics in combination with high infant postnatal antibiotics were not statistically different for NSD (OR 0.48, P = .12).
    Discussion Antibiotic prophylaxis before delivery has become commonplace as therapy for a number of potential diseases. Some estimates report that >40% of all pregnant women receive antibiotics before delivery for either prophylaxis for GBS or cesarean delivery.13, 14 When other indications for antibiotics are taken into account, such as prevention of premature birth and chorioamnionitis, the percentage of mothers receiving antibiotics is even greater. In a 2015 study from Canada, the authors noted that 39% of 449 mothers undergoing term delivery were given intrapartum antibiotics, indirectly exposing their infants to antibiotics. In our study, maternal indications for antibiotic therapy included but were not limited to GBS prophylaxis, cesarean delivery, and premature rupture of membranes. In our study, 62.3% of mothers received antibiotics before delivery, most commonly ampicillin (37.6%) and azithromycin (26.4%). The prevalence of maternal antibiotic use (62.3%) found in this study may be greater than previously reported (40%) due to the different study populations (infants born premature vs at term). Our finding regarding prenatal antibiotic exposure and protection against NEC is in stark contrast to the findings reported by Weintraub et al. In their retrospective case-control study, they noted that in 97 matched pairs of infants born preterm, NEC was more than twice as likely to occur among infants with prenatal exposure to ampicillin. A Cochrane review of prenatal antibiotics given to mothers for premature rupture of membranes noted that among the various antibiotics given, amoxicillin–clavulanate was the only antibiotic that increased neonatal risk for NEC. Our findings are also contrary to our expectation due to increased risk of NEC reported in previous studies associated with postnatal empiric antibiotic use.5, 6, 7, 18, 19 Speculation that prenatal antibiotics would have a similar association with neonatal disease as postnatal antibiotics appears to be incorrect. The trend that we observed toward increased risk for LOS associated with prenatal antibiotic exposure was not statistically significant. Nevertheless, we consider the findings of concern, given previous reports. Lin et al noted that in 1 hospital, after the initiation of a standardized treatment protocol for intrapartum antibiotic prophylaxis for GBS, the use of maternal antibiotics increased from 40% to 90% over 4 years in GBS-positive mothers, during which time GBS-associated early-onset sepsis in neonates decreased (45% to 20%) and E coli–associated early-onset sepsis increased proportionally (41%-70%). Similarly, in a study of >5400 very low birth weight infants from the Eunice Kennedy Shriver National Institute of Child Health and Human Development in 2002, researchers reported a change in the pathogens causing early-onset sepsis from predominantly gram-positive to predominantly gram-negative organisms, which correlates with the increase in maternal antibiotic prophylaxis during labor and delivery. A retrospective review of early-onset sepsis and LOS and ampicillin resistance demonstrated that increasing use of intrapartum antibiotics was an independent risk factor for ampicillin-resistant E coli–associated early-onset sepsis and an increase in E coli–associated LOS. Similarly, Didier et al found that maternal antibiotic exposure was significantly associated with the risk of amoxicillin-resistant E coli infections. Coagulase-negative Staphylococcus was the causal organism in nearly one-half of LOS cases. Although this organism is generally considered to have low pathogenic potential, this is not always the case for infants born extremely preterm. Moreover, in this study 2 deaths attributable to LOS were caused by coagulase-negative Staphylococcus.