BACKGROUND AND PURPOSE:

• Siegel et al. (American Journal of Perinatology Reports, 2019) examined the impact of non-penicilllin (PCN) regimens on neonatal outcomes

METHODS:

• 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
• Participants
  • Singleton, nonanomalous pregnancy
  • Enrollment ≥24w0d | Delivery <35w0d
• Interventions
  • 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)
• Primary outcome
  • Composite of neonatal outcomes
    • NEC | Severe IVH | PVL | Bronchopulmonary dysplasia | Neonatal death prior to hospital discharge | Sepsis | Cerebral palsy
• Secondary outcomes
  • Separate components of composite neonatal outcomes
  • Pregnancy latency (days from rupture to delivery)
  • Endometritis
  • Chorioamnionitis

RESULTS:

• 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)
• Maternal outcomes
  • 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

CONCLUSION:

• Non-PCN regimens
  • 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

Learn More – Primary Sources:

The Effect of Non-penicillin Antibiotic Regimens on Neonatal Outcomes in Preterm Premature Rupture of Membranes

Related ObG Topics:

ACOG Guidance Update: Diagnosis and Management of PROM (Prelabor Rupture of Membranes)

Do Common Antibiotics Increase Risk of Congenital Malformations?

How Do Alternative Antibiotics Regimens to Prevent Surgical Site Infection Following Cesarean Section compare to Cefazolin?

Can Azithromycin be Used as an Alternative to Erythromycin for PPROM?