Antibiotics on incidence of infection in neonates with meconium-stained amniotic fluid
Keywords:
meconium-stained amniotic fluid, antibiotic, neonatal infection markers
Abstract
Background The effectiveness of antibiotics for preventinginfection in neonates with meconium-stained amniotic fluid
(MSAF) remains unclear. Not all neonates with MSAF develop
meconium aspiration syndrome (MAS) or neonatal infection.
Furthermore, neonatal infection diagnosis may be difficult due
to lack of symptoms. As such, clinical manifestations, laboratory
results, and infection markers are important for diagnosis.
Objective To evaluate antibiotic use on the incidence ofinfection
in neonates with MSAF.
Methods This double-blind randomized controlled clinical trial
was performed at Dr. Kariadi Hospital, Semarang, Indonesia from
October 2009 to March 2010. Subjects were newborns with MSAF
who were diagnosed by two observers (Kappa test intraobserver
agreement was 0.74) and with feces metabolites found in their
amniotic fluid. Sixty-nine newborns were divided into groups I
and II, comprised of 35 and 34 subjects, respectively. Group I
subjects (control group) were not given antibiotics, while group
II subjects (treatment group) were given combination antibiotics
of ampicillin (50 mg;kg BW) and gentamicin (8 mg;kg BW), as
single doses. Neonatal infection diagnosis was based on clinical
manifestations, laboratory results (leucocyte count, blood culture,
and I: T ratio), and the following infection markers: procalcitonin
(PCT), interleukin-6 (IL-6), tumor necrosis tumor-a (TNF-a),
and C-reactive protein (CRP). Chi-square and Fischer's exact
tests were used for statistical analyses.
Results We found no significant differences in the incidence of
neonatal infection between those who received and those who
did not receive antibiotics, based on clinical manifestations, the
first and second examination of laboratory marker (P=0.53),
examinations of CRP, IL-6, TNF-a, and PCT either as single
markers or combinations of 2, 3, or 4 markers (P> 0.05) , as well
as mortality rate (P=0.30).
Conclusion There is no significant difference in the incidence
of infection in neonates with MSAF who received prophylactic antibiotics compared to those who did not receive antibiotics.
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Textbook of neonatal resuscitation. 5th ed. American
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E, Weiss K, et al. Delivery room management of the
apparently vigorous meconium-stained neonate: results of
the multicentei; international collaborative trial. Pediatrics.
2000;105:1-7.
3. Rao S, Pavlova Z, Incerpi MH, Ramanathan R. Meconiumstained
amniotic fluid and neonatal morbidity in near-term
and term deliveries with acute histologic chorioamnionitis
and/or funisitis. J Perinatol. 2001;21 :537- 40.
4. Gelfand SL, Fanaroff JM, Walsh MC. Meconium stained
fluid: approach to the mother and the baby. Pediatr Clin N
Am. 2004;51:655-67.
5. Hatherill M, Tibby SM, Syke K, Turner C, Mur IA. Diagnostic
markers of infection: comparison of procalcitonin with
C-reactive protein and leukocyte count. Arch Dis Child.
1999;81:417-21.
6. Benitz WE, Han MY, Madan A, Ramachandra P. Serial
serum C-reactive protein levels in the diagnosis of neonatal
infection. Pediatrics. 1998; 102 :E4 l.
7. Okazaki K, Kondo M, Kato M, Kakinuma R, Nishida A,
Noda M, et al. Serum cytokine and chemokine profiles in
neonates with meconium aspiration syndrome. Pediatrics.
2008; 121: 7 48-53.
8. Shivananda S, Murthy P, Shah PS. Antibiotics for neonates
born through meconium stained amniotic fluid. Cochrane Database of Systematic Reviews 2006, Issue 4. Art. No:
CD006183. DOI: 10.1002/14651858.CD006183.
9. Mudd PA. Ototoxicity. Medscape Reference [cited January
2013]. Available from: htrp: //emedicine.medscape.com/
article/85 7679-overview
10. McCracken GH Jr. Aminoglycoside toxicity in infants and
children. Am J Med. 1986;80:172-8.
11. BUPA Cromwell Hospital. Neonatal unit antibiotic guidelines.
2010 [cited January 2013]. Available from: http: //www.
infectioncontrolservices.co.uk/documents/cromwell/antibiotics/
Neonatal_ Unit_ Antibiotic_ Guidelines_ Sept_2009.pdf
12. Newborn Services Clinical Guideline. Meconium-stained
liquor and meconium aspiration. 2004 [cited April 2008] .
Available from: http://www.adhb.govt.nz/newborn/Guidelines/
Admission/MeconiumStainedLiquor AndMAS.htm
13. P Ng, S Cheng, K Chui, T Fok, M Wong, W Wong, et al.
Diagnosis of late onset neonatal sepsis with cytokines,
adhesion molecule, and C-reactive protein in preterm very
low birth weight infants. Arch Dis Child Fetal Neonatal Ed.
1997;77:F221-7.
14. Dasa Tjipt G, Azlin E, Sianturi P, Lubis BG. Gawat Napas
pada neonatus. [cited 2012 March]. Available from: www.
ocw. usu.ac. id. ka slide gawat napas pada neonatus. pdf
15. Askep kapukonline.com. Askep asuhan keperawatan aspirasi
mekonium anak. [cited 2010 January]. Available from: http: //
www.kapukonline.com/2010/03/askepaspirasimekoniumanak.htm
16. Ng PC. Diagnostic markers of infection in neonates. Arch
Dis Child Fetal Neonatal Ed. 2004;89:F229-35.
l 7. Chiesa C, Panero A, Rossi N, Stegagno M, De Giusti M,
Osborn JF, et al. Reliability of procalcitonin concentrations
for the diagnosis of sepsis in critically neonates. Clin Infect
Dis. 1998;26:664-72.
18. Ratanakorn W, Srijariya W, Chamnanvanaki S, Saengaroon
P. Incidence of neonatal infection in newborn infants with
a maternal history of premature rupture of membranes
(PROM) for 18 hours or longer by using Phramongkutklao
Hospital Clinical Practice Guideline (CPG). J Med Assoc
Thai. 2005 ;88:973-8.
19. Darmawati T, Surjono A, Wandita S. Evaluasi antibiotik
profileksi pada neonatus dengan potensial terinfeksi terhadap
kejadian sepsis neonatorum klinis dini di RS. Dr. Sardjito,
Yogyakarta. B.I.Ked. 2001;33 :131-7.
20. Siriwachirachai T, Sangkomkamhang US, Lumbiganon P,
Laopaiboon M. Antibiotics for meconium-stained amniotic
fluid in labour for preventing maternal and neonatal
infections. Cochrane Database of Systematic Reviews 2010,
Issue 12. Art. No.: CD007772. DOI: 10.1002/14651858.
CD007772.pub2.
Published
2013-02-28
How to Cite
1.
Kosim M, Noerpramana N, Aminullah A, Hadisaputro S. Antibiotics on incidence of infection in neonates with meconium-stained amniotic fluid. PI [Internet]. 28Feb.2013 [cited 23Nov.2024];53(1):50-. Available from: https://paediatricaindonesiana.org/index.php/paediatrica-indonesiana/article/view/249
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Received 2016-08-18
Accepted 2016-08-18
Published 2013-02-28
Accepted 2016-08-18
Published 2013-02-28
