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Observational Study
. 2022 May 17:377:e069704.
doi: 10.1136/bmj-2021-069704.

Long term impact of prophylactic antibiotic use before incision versus after cord clamping on children born by caesarean section: longitudinal study of UK electronic health records

Dana Šumilo  1   2 , Krishnarajah Nirantharakumar  3   4 , Brian H Willis  3 , Gavin M Rudge  3 , James Martin  3 , Krishna Gokhale  3 , Rasiah Thayakaran  3 , Nicola J Adderley  3 , Joht Singh Chandan  3 , Kelvin Okoth  3 , Isobel M Harris  3 , Ruth Hewston  5 , Magdalena Skrybant  5 , Jonathan J Deeks  3   6 , Peter Brocklehurst  3
Affiliations
Observational Study

Long term impact of prophylactic antibiotic use before incision versus after cord clamping on children born by caesarean section: longitudinal study of UK electronic health records

Dana Šumilo et al. BMJ. .

Abstract

Objective: To investigate the impact on child health up to age 5 years of a policy to use antibiotic prophylaxis for caesarean section before incision compared with after cord clamping.

Design: Observational controlled interrupted time series study.

Setting: UK primary and secondary care.

Participants: 515 945 children born in 2006-18 with linked maternal records and registered with general practices contributing to two UK primary care databases (The Health Improvement Network and Clinical Practice Research Datalink), and 7 147 884 children with linked maternal records in the Hospital Episode Statistics database covering England, of which 3 945 351 were linked to hospitals that reported the year of policy change to administer prophylactic antibiotics for caesarean section before incision rather than after cord clamping.

Intervention: Fetal exposure to antibiotics shortly before birth (using pre-incision antibiotic policy as proxy) compared with no exposure.

Main outcome measures: The primary outcomes were incidence rate ratios of asthma and eczema in children born by caesarean section when pre-incision prophylactic antibiotics were recommended compared with those born when antibiotics were administered post-cord clamping, adjusted for temporal changes in the incidence rates in children born vaginally.

Results: Prophylactic antibiotics administered before incision for caesarean section compared with after cord clamping were not associated with a significantly higher risk of asthma (incidence rate ratio 0.91, 95% confidence interval 0.78 to 1.05) or eczema (0.98, 0.94 to 1.03), including asthma and eczema resulting in hospital admission (1.05, 0.99 to 1.11 and 0.96, 0.71 to 1.29, respectively), up to age 5 years.

Conclusions: This study found no evidence of an association between pre-incision prophylactic antibiotic use and risk of asthma and eczema in early childhood in children born by caesarean section.

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Conflict of interest statement

Competing interests: All authors have completed the ICMJE uniform disclosure form at www.icmje.org/coi_disclosure.pdf and declare: no support from any organisation for the submitted work; no financial relationships with any organisations that might have an interest in the submitted work in the previous three years; KN reports grants from the Medical Research Council, National Institute for Health and Care Research (NIHR), Health Data Research UK, Action Against Age-related Macular Degeneration, and personal fees from Boehringer Ingelheim, Sanofi, Cegedim, and MSD. BHW reports being in receipt of an MRC clinician scientist award during the conduct of the study. JM reports funding from the Gates Foundation. JSC reports grant funding from the NIHR and Youth Endowment Fund. MS has been funded through the NIHR Applied Research Collaboration (ARC) West Midlands, during the conduct of the study.

Comment in

References

    1. Boerma T, Ronsmans C, Melesse DY, et al. . Global epidemiology of use of and disparities in caesarean sections. Lancet 2018;392:1341-8. 10.1016/S0140-6736(18)31928-7 - DOI - PubMed
    1. Leth RA, Møller JK, Thomsen RW, Uldbjerg N, Nørgaard M. Risk of selected postpartum infections after cesarean section compared with vaginal birth: a five-year cohort study of 32,468 women. Acta Obstet Gynecol Scand 2009;88:976-83. 10.1080/00016340903147405 - DOI - PubMed
    1. Smaill FM, Grivell RM. Antibiotic prophylaxis versus no prophylaxis for preventing infection after cesarean section. Cochrane Database Syst Rev 2014;(10):CD007482. 10.1002/14651858.CD007482.pub3 - DOI - PMC - PubMed
    1. Mackeen AD, Packard RE, Ota E, Berghella V, Baxter JK. Timing of intravenous prophylactic antibiotics for preventing postpartum infectious morbidity in women undergoing cesarean delivery. Cochrane Database Syst Rev 2014;(12):CD009516. 10.1002/14651858.CD009516.pub2 - DOI - PMC - PubMed
    1. National Institute for Health and Care Excellence . Caesarean section. NICE Clinical guideline CG132. National Institute for Health and Care Excellence, 2011.

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