ADJUNCTIVE ANTIBIOTIC-TREATMENT IN PRETERM LABOR AND NEONATAL MORBIDITY - A METAANALYSIS

Objective: To estimate the effect of prophylactic antibiotics on neona tal mortality and morbidity in patients with preterm labor, based on a meta-analysis of seven published randomized clinical trails. Data Sou rces: We searched 18 medical data bases, including MEDLINE from 1964 a nd EMBASE from 1974, to identify all literature included under preterm or premature labor and antibiotics. We scanned all abstracts from the computer printouts, the retrieved full-text reports, the references f rom each retrieved report, and review articles to determine whether st udies met our inclusion criteria. Methods of Study Selection: The foll owing criteria were used to select studies for inclusion: article-orig inal published report written in English; study design-randomized cont rolled trial; population-patients with preterm labor, defined as labor before 37 weeks' gestation; intervention-antibiotic treatment; and on e or more of the following outcomes-neonatal mortality, sepsis, pneumo nia, respiratory distress syndrome, intraventricular hemorrhage, and n ecrotizing enterocolitis. Tabulation, Integration, and Results: We ana lyzed study patients and methods, and abstracted quantitative outcome data. For each outcome, both odds ratio (OR) and 95% confidence interv al (CI) were calculated. Seven trials, published between 1989 and 1995 included a total of 795 patients. Adjunctive antibiotic therapy appea red to reduce the risk of pneumonia (OR 0.45, 95% CI 0.12-1.72) and ne crotizing enterocolitis (OR 0.38, 95% CI 0.14-1.08) and to increase th e risk of neonatal mortality (OR 3.25, 95% CI 0.93-11.38), but it had no effect on neonatal sepsis (OR 0.98, 95% CI 0.34-2.83), respiratory distress syndrome (OR 0.93, 95% CI 0.54-1.87), and intraventricular he morrhage (OR 1.01, 95% CI 0.20-5.10). None of the effects observed rea ched a significance level of P < .05. Conclusion: The results of this meta-analysis do not support the routine use of adjunctive antibiotic treatment in patients with preterm Labor diagnosed on the basis of sub jective uterine contractions and the resulting cervical changes.