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Published on: January 27, 2019
Prophylactic antibiotics to reduce morbidity and mortality in ventilated newborn infants
1Grantley Stable Neonatal Unit, Royal Women's Hospital, Butterfield St, Herston, Brisbane, Queensland, Australia.
Insights
Prophylactic antibiotics for intubated newborns lack evidence for efficacy or harm. More high-quality studies are needed to determine if these treatments benefit or harm mechanically ventilated infants.
Area of Science:
- Neonatal Medicine
- Pediatric Critical Care
- Infectious Diseases
Background:
- Bacterial colonization of the respiratory tract is common in intubated newborns, increasing infection risk and potential for chronic lung disease.
- Prophylactic antibiotics are proposed to reduce colonization and infection but may cause harm.
- The balance of benefit versus harm for prophylactic antibiotics in this population is unclear.
Purpose of the Study:
- To evaluate the effectiveness of prophylactic antibiotics in reducing mortality and morbidity in intubated, ventilated newborn infants without known infection.
- To compare prophylactic antibiotic use from intubation versus placebo/no treatment.
- To compare continuing versus discontinuing antibiotics in infants with negative initial sepsis cultures.
Main Methods:
- Searched MEDLINE, CINAHL, and the Cochrane Central Register of Controlled Trials (up to May 2003).
- Included randomized controlled trials (RCTs) of sufficient quality involving mechanically ventilated newborns.
- Two reviewers independently assessed trial quality.
Main Results:
- Only one study of insufficient quality met the inclusion criteria.
- The available evidence is limited and of poor quality.
Conclusions:
- There is insufficient evidence from RCTs to support or refute the use of prophylactic antibiotics in intubated, ventilated newborns.
- Evidence is lacking to guide the continuation or discontinuation of antibiotics after negative initial cultures in this population.
Background:
Bacterial colonisation of the respiratory tract is associated with intubation and may increase the risk of acquiring infection. This may prolong the need for mechanical ventilation and increase the risk of chronic lung disease. The use of prophylactic antibiotics has been advocated for all mechanically ventilated newborns in order to reduce the risk of colonisation and acquired infection. Countering this is the possibility that harm may outweigh benefit.
Objectives:
To assess the effects of prophylactic antibiotics in reducing mortality and morbidity in intubated and ventilated newborn infants who are not known to have infection. In separate comparisons, we reviewed two different policies regarding the prophylactic use of antibiotics in intubated, ventilated infants: 1) among babies who are being intubated for mechanical ventilation, a policy of prophylactic antibiotics for the duration of intubation versus placebo or no treatment. 2) among intubated, ventilated babies who had been started on antibiotics at the time of intubation but whose initial cultures to rule our sepsis are negative, a policy of continuing versus discontinuing prophylactic antibiotics.
Search Strategy:
We searched MEDLINE (January 1966 to May 2003), CINAHL (1982 to May 2003), the Cochrane Central Register of Controlled Trials (The Cochrane Library, Issue 1, 2003), the Cochrane Neonatal Group Specialised Register and reference lists of articles.
Selection Criteria:
Randomised controlled trials of sufficient quality in which mechanically ventilated newborn infants are randomised to receive prophylactic antibiotics versus placebo or no treatment.
Data Collection And Analysis:
Two reviewers independently assessed trial quality.
Main Results:
One study, of insufficient quality, met the criteria for inclusion in this review.
Reviewer'S Conclusions:
There is no evidence from randomised trials to support or refute the use of prophylactic antibiotics when commencing mechanical ventilation in newborn infants, or to support or refute continuing antibiotics once initial cultures rule out infection in mechanically ventilated newborn infants.
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