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Published on: July 13, 2019
Prophylactic antibiotics to reduce morbidity and mortality in newborn infants with intercostal catheters
Alice Stewart1, Garry D T Inglis, Luke A Jardine
1Monash Newborn, Monash Medical Centre, Clayton, Australia. AliceE.Stewart@southernhealth.org.au.
Insights
No randomized trials exist to confirm or deny antibiotic prophylaxis for neonates with intercostal catheters. Further research is needed to assess the impact on infection and mortality in this vulnerable population.
Area of Science:
- Neonatal medicine
- Infectious disease control
- Pediatric surgery
Background:
- Intercostal catheters are vital for draining intrathoracic issues in newborns, such as pneumothorax.
- Catheter insertion breaches the skin barrier, increasing the risk of nosocomial infections.
- Antibiotic prophylaxis may prevent infections but risks promoting resistant bacteria.
Purpose of the Study:
- To evaluate the efficacy of prophylactic antibiotics versus selective use in reducing mortality and morbidity, particularly septicaemia, in neonates undergoing intercostal catheter placement.
Main Methods:
- Searched Cochrane Central Register of Controlled Trials, MEDLINE, and CINAHL for relevant studies.
- Included randomized controlled trials (RCTs) or quasi-randomized trials comparing prophylactic antibiotics to placebo or no treatment.
- Utilized standard Cochrane Neonatal Review Group methodologies for data collection and analysis.
Main Results:
- No randomized controlled trials meeting the eligibility criteria were identified.
- The current evidence base lacks RCTs to support or refute the use of prophylactic antibiotics.
Conclusions:
- There is insufficient evidence from RCTs to guide the use of antibiotic prophylaxis for intercostal catheter insertion in neonates.
- Future RCTs should consider that neonates may already be on antibiotics for other conditions.
Background:
Intercostal catheters are commonly used for the drainage of intrathoracic collections in newborn infants, including pneumothorax and pleural effusions. Placement of an intercostal drain is a potential risk factor for nosocomial infection due to breach of the cutaneous barrier. Therefore, neonates who require intercostal drainage, especially those in high risk groups for nosocomial infection, may benefit from antibiotic prophylaxis. However, injudicious antibiotic use carries the risk of promoting the emergence of resistant strains of micro-organisms or of altering the pattern of pathogens causing infection.
Objectives:
To determine the effect of prophylactic antibiotics compared to selective use of antibiotics on mortality and morbidity (especially septicaemia) in neonates undergoing placement of an intercostal catheter.
Search Methods:
The standard search strategy of the Cochrane Neonatal Review Group was used to search the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2011, Issue 5), MEDLINE (1948 to June 2011) and CINAHL (1982 to June 2011).
Selection Criteria:
Randomised controlled trials or some types of non-randomised (that is, quasi-randomised) controlled trials of adequate quality in which either individual newborn infants or clusters of infants were randomised to receive prophylactic antibiotics versus placebo or no treatment.
Data Collection And Analysis:
We used the standard methods of the Cochrane Neonatal Review Group.
Main Results:
We did not find any randomised controlled trials that met the eligibility criteria.
Authors' Conclusions:
There are no data from randomised trials to either support or refute the use of antibiotic prophylaxis for intercostal catheter insertion in neonates. Any randomised controlled trials of antibiotic prophylaxis would need to account for the fact that neonates who require insertion of an intercostal catheter may already be receiving antibiotics for other indications.
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