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Published on: July 13, 2019
Prophylactic antibiotics to reduce morbidity and mortality in neonates with umbilical artery catheters
1Grantley Stable Neonatal Unit, Royal Women's Hospital, Butterfield St, Herston, Brisbane, Queensland, Australia, 4029.
Insights
No studies were found to determine if prophylactic antibiotics benefit neonates with umbilical artery catheters. More research is needed to assess the safety and efficacy of antibiotic use in these vulnerable infants.
Area of Science:
- Neonatal care
- Infectious disease prevention
- Clinical trial methodology
Background:
- Umbilical artery catheters are crucial for monitoring unwell neonates.
- Catheter-related infections pose significant risks, including morbidity and mortality.
- Prophylactic antibiotics are considered to prevent colonization and infection, but potential harms exist.
Purpose of the Study:
- To evaluate the effectiveness of prophylactic antibiotics in reducing mortality and morbidity in neonates with umbilical artery catheters.
- To compare policies of prophylactic antibiotic use (duration of catheterization vs. placebo/no treatment).
- To assess the impact of continuing versus discontinuing antibiotics when initial sepsis cultures are negative.
Main Methods:
- Searched major databases (MEDLINE, CINAHL, CENTRAL) from 1966 to 2004.
- Included randomized controlled trials of sufficient quality.
- Two independent reviewers assessed trial quality.
Main Results:
- No studies met the inclusion criteria for this review.
- The available evidence base is insufficient to draw conclusions.
Conclusions:
- Currently, no randomized trial evidence supports or refutes the use of prophylactic antibiotics for umbilical artery catheters in neonates.
- Evidence is lacking to guide decisions on continuing antibiotics after negative initial sepsis cultures.
Background:
Umbilical artery catheters are often used in unwell neonates. Infection related to the use of these catheters may cause significant morbidity and mortality. The use of prophylactic antibiotics has been advocated for all newborns with umbilical artery catheters in order to reduce the risk of colonisation and acquired infection. Countering this is the possibility that harm may outweigh benefit.
Objectives:
The primary objective was to assess whether prophylactic antibiotics, in neonates with umbilical artery catheters, reduce mortality and morbidity. In separate comparisons, we planned to review two different policies regarding the prophylactic use of antibiotics in neonates with umbilical artery catheters: 1) among neonates with umbilical artery catheters, a policy of prophylactic antibiotics for the duration of catheterisation (or other fixed duration of antibiotic treatment) versus placebo or no treatment; 2) among neonates with umbilical artery catheters who had been started on antibiotics at the time of catheterisation but whose initial cultures to rule out sepsis are negative, a policy of continuing versus discontinuing prophylactic antibiotics.
Search Strategy:
We searched MEDLINE (January 1966 to February 2004), CINAHL (1982 to February 2004), the Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library, Issue 1, 2004), the Cochrane Neonatal Group Specialised Register and reference lists of articles.
Selection Criteria:
Randomised controlled trials of adequate quality in which newborn infants with umbilical artery catheters are randomised to receive prophylactic antibiotics versus placebo or no treatment.
Data Collection And Analysis:
Two reviewers independently assessed trial quality.
Main Results:
No study met the criteria for inclusion in this review.
Reviewers' Conclusions:
There is no evidence from randomised trials to support or refute the use of prophylactic antibiotics when umbilical artery catheters are inserted in newborn infants, or to support or refute continuing antibiotics once initial cultures rule out infection in newborn infants with umbilical artery catheters.
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