Does the combined antenatal use of corticosteroids and antibiotics increase late-onset neonatal sepsis in the very low birth weight infant?

OBJECTIVE: The purpose of this study was to determine whether the combined use of maternal antenatal corticosteroids and antibiotic therapy is associa ted with an Increased risk of late-onset neonatal sepsis among very low bir th weight Infants. STUDY DESIGN. The outcomes of infants admitted to the 3 Cincinnati neonatal intensive care units between May 1991 and May 2000 were retrospectively ev aluated. Late-onset neonatal sepsis was defined either as the occurrence of a positive blood culture obtained after 72 hours of life with clinical sig ns of sepsis or as the need for >5 consecutive days of antibiotic therapy f or presumed sepsis that initiated after 72 hours of life. Wilcoxon rank sum , chi-square test, and multiple logistic regression were used for analysis. RESULTS: Among the parturients delivering the study infants, 434 women (24% ) received corticosteroids only, 175 women (9%) received antibiotics only, 819 women (46%) received both corticosteroids and antibiotics, and 370 wome n (20%) received neither corticosteroids nor antibiotics, Among 1978 study infants, there were 732 infants (41%) with late-onset neonatal sepsis. By u nivariate analysis, the odds ratio for late-onset neonatal sepsis caused by combined corticosteroid and antibiotic use was 0.96 (95% Cl, 0.89%, 1.04%) . Multiple logistic regression analysis was used to evaluate the risk of co mbined corticosteroids and antibiotic use after controlling for potential c ovariates and confounders. After controlling for outborn birth (odds ratio, 1.3 95% Cl, 1.0%-1.8%), increasing gestational age at delivery (odds ratio , 0.63 95% Cf, 0.60%-0.66%), interaction between white race and male gender (P = .01) and interaction between antibiotics and prolonged rupture of mem branes (P = .02), the use of corticosteroids and antibiotics was not associ ated with an increased risk of late-onset neonatal sepsis (P = .9). CONCLUSION: The combined use of maternal corticosteroids and antibiotic the rapy Is not associated with an increased risk for late-onset neonatal sepsi s.