Antibiotics in Infants For Premature Rupture Of Membranes

Abstract

CHICAGOWhen newborn infants succumb to severe infection during the first few days of life, predisposing maternal factor such as infection, prolonged labor, and premature rupture of amniotic membranes have been implicated.1,2 Several reports have indicated a direct correlation between early rupture of the amniotic membranes and neonatal infection, especially in association with prolonged labor. [3][4][5]8 However, the beneficial effects of prophylactic antibiotics in the prevention of infection in the newborn under these circumstances still are not clear. VonFriesen reported that small doses of sulfamerazine,6 and Smith and his co-workers, that a combination of penicillin and tetra-cycline7 resulted in decreased neonatal morbidity and rate of infection when administered to mothers with fever, prolonged labor, and premature rupture of amniotic membranes. Blanc 8 and Pfaeffli,9 however, did not observe a beneficial effect when penicillin and streptomycin were used as the prophylactic antibiotics.Equivocal results have been reported when prophylactic antibiotics were administered to full-term infants born after premature rup¬ ture of the amniotic membranes.1012 Al¬ though it is generally agreed that premature infants are more susceptible to infection than full-term infants, Silverman 13 pointed out that there is still insufficient evidence to warrant administration of prophylactic anti¬ biotics to premature infants who have been exposed to amnionitis.Our study was undertaken to determine whether prophylactic administration of peni¬ cillin and streptomycin would prevent infec¬ tion in premature infants who were born after premature rupture of the amniotic membranes. Subjects and MethodsService infants admitted to the Michael Reese Hospital premature nursery, with rupture of amniotic membranes more than 18 hours prior to delivery according to history, were chosen for the study if they fulfilled the following require¬ ments : ( 1 ) infant's age was under 24 hours at the time of admission, (2) absence of a history of maternal fever, purulent vaginal discharge, or antibiotic treatment, (3) absence of severe con¬ genital anomalies, respiratory distress syndrome, or other illness requiring specific therapy.Shortly after admission the following specimens for bacterial cultures were obtained from each infant: (1) venous blood from the antecubital vein obtained by the technique described by Eitz-man1* wherein hexachlorophene pHisoHex, 1% tincture of iodine, and 70% ethyl alcohol were used as sterilizing agents, (2) nasopharyngeal swab, (3) throat swab, (4) cord stump swab, (5) stool by rectal swab, and (6) gastric aspirate.

Premature Rupture of Membranes and Effects of Prophylactic Antibodies

“…Pryles and his colleagues (1963) based their study on those cases where rupture had taken place 6 hours or more before delivery. Oh et al (1964) used a somewhat longer period of 18 hours. A more common convention is to regard as premature, rupture of the membranes occurring 24 'hours or more before delivery (Wilson et al, 1964).…”

Renal Function and Blood Volume in Newborn Infant Related to Placental Transfusion

“…The effectiveness of antibiotics in the newborn infant for prophylaxis against infection is yet to be clarified [18]. None were used in our infants.…”