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Meta-Analysis
. 2010 Apr;39 Suppl 1(Suppl 1):i134-43.
doi: 10.1093/ije/dyq030.

Antibiotics for pre-term pre-labour rupture of membranes: prevention of neonatal deaths due to complications of pre-term birth and infection

Simon Cousens  1 , Hannah Blencowe, Michael Gravett, Joy E Lawn
Affiliations
Meta-Analysis

Antibiotics for pre-term pre-labour rupture of membranes: prevention of neonatal deaths due to complications of pre-term birth and infection

Simon Cousens et al. Int J Epidemiol. 2010 Apr.

Abstract

Background: In high-income countries, it is standard practice to give antibiotics to women with pre-term, pre-labour rupture of membranes (pPROM) to delay birth and reduce the risk of infection. In low and middle-income settings, where some 2 million neonatal deaths occur annually due to complications of pre-term birth or infection, many women do not receive antibiotic therapy for pPROM.

Objectives: To review the evidence for and estimate the effect on neonatal mortality due to pre-term birth complications or infection, of administration of antibiotics to women with pPROM, in low and middle-income countries.

Methods: We performed a systematic review to update a Cochrane review. Standardized abstraction forms were used. The quality of the evidence provided by individual studies and overall was assessed using an adapted GRADE approach.

Results: Eighteen RCTs met our inclusion criteria. Most were from high-income countries and provide strong evidence that antibiotics for pPROM reduce the risk of respiratory distress syndrome [risk ratio (RR) = 0.88; confidence interval (CI) 0.80, 0.97], and early onset postnatal infection (RR = 0.61; CI 0.48, 0.77). The data are consistent with a reduction in neonatal mortality (RR = 0.90; CI 0.72, 1.12).

Conclusion: Antibiotics for pPROM reduce complications due to pre-term delivery and post-natal infection in high-income settings. There is moderate quality evidence that, in low-income settings, where access to other interventions (antenatal steroids, surfactant therapy, ventilation, antibiotic therapy) may be low, antibiotics for pPROM could prevent 4% of neonatal deaths due to complications of prematurity and 8% of those due to infection.

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Figures

Figure 1
Figure 1
Fixed effects meta-analysis of the effect of antibiotics for pPROM on neonatal mortality
Figure 2
Figure 2
Fixed effects meta-analysis of the effect of antibiotics for pPROM on the risk of respiratory distress syndrome
Figure 3
Figure 3
Fixed effects meta-analysis of the effect of antibiotics for pPROM on the risk of necrotizing enterocolitis
Figure 4
Figure 4
Fixed effects meta-analysis of the effect of antibiotics for pPROM on the risk of intra-ventricular haemorrhage
Figure 5
Figure 5
Fixed effects meta-analysis of the effect of antibiotics for pPROM on the risk of confirmed sepsis
See this image and copyright information in PMC

References

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    1. Segel SY, Miles AM, Clothier B, et al. Duration of antibiotic therapy after preterm premature rupture of fetal membranes. Am J Obst Gynecol. 2003;189:799–802. - PubMed

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