Non-Penicillin Regimen for PPROM: What are the Outcomes?
BACKGROUND AND PURPOSE:
Siegel et al. (American Journal of Perinatology Reports, 2019) examined the impact of non-penicilllin (PCN) regimens on neonatal outcomes
Secondary analysis of an RCT
Beneficial Effects of Antenatal Magnesium sulfate (BEAM) study (NICHD MFMU): Study aim was to assess use of magnesium sulfate for prevention of cerebral palsy
Singleton, nonanomalous pregnancy
Enrollment ≥24w0d | Delivery <35w0d
Standard of care: 7-day course of PCN and macrolide (NICHD ‘gold standard’ – see ‘Related ObG Topics’ below)
Non-β-lactam regimen and a macrolide (NPCR)
Composite of neonatal outcomes
NEC | Severe IVH | PVL | Bronchopulmonary dysplasia | Neonatal death prior to hospital discharge | Sepsis | Cerebral palsy
Separate components of composite neonatal outcomes
Pregnancy latency (days from rupture to delivery)
A total of 949 women
Standard care: 56%
NPCR: 8.8% | Within NPCR group, 64.1% received clindamycin
No difference in primary outcome between NPCR vs standard care
Adjusted odds ratio (aOR) 0.50 (95% CI, 0.22 to 1.11)
Neonates receiving standard care were
Less likely to have bronchopulmonary dysplasia (p=0.03)
More likely to have severe necrotizing enterocolitis (p=0.04)
No difference between groups for chorioamnionitis and median latency
Endometritis risk was reduced with use of standard care
aOR 0.35; 95% CI 0.14 to 0.91
Did not differ from gold standard regimen for composite neonatal outcome or latency
Increased the risk for endometritis
Increased the risk for bronchopulmonary dysplasia
Further studies are needed to follow up on current findings and to assess differences in individual neonatal morbidities
The authors state that
practitioners should appropriately use cephalosporins in patients with a nonsignificant PCN allergy and should consider PCN allergy testing in all pregnant women with significant allergies to optimize maternal and neonatal outcomes in pregnancies affected by PPROM in the setting of PCN allergy
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