Prophylactic antibiotics to reduce morbidity and mortality in ventilated newborn infants

Inglis, Garry D. T., Jardine, Luke A. and Davies, Mark W. (2007) Prophylactic antibiotics to reduce morbidity and mortality in ventilated newborn infants. Cochrane Database of Systematic Reviews, 3: CD004338.1-CD004338.17. doi:10.1002/14651858.CD004338.pub3

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Author Inglis, Garry D. T.
Jardine, Luke A.
Davies, Mark W.
Title Prophylactic antibiotics to reduce morbidity and mortality in ventilated newborn infants
Journal name Cochrane Database of Systematic Reviews   Check publisher's open access policy
ISSN 1469-493X
Publication date 2007-03-01
Sub-type Critical review of research, literature review, critical commentary
DOI 10.1002/14651858.CD004338.pub3
Issue 3
Start page CD004338.1
End page CD004338.17
Total pages 17
Place of publication Oxford, United Kingdom
Publisher John Wiley & Sons
Language eng
Subject 321019 Paediatrics
C1
730204 Child health
11 Medical and Health Sciences
1114 Paediatrics and Reproductive Medicine
Formatted abstract
Background
Umbilical venous 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 newborns with umbilical venous catheters in order to reduce the risk of colonisation and acquired infection. Countering this is the possibility that harm may outweigh benefit. Prophylactic antibiotics may be effective in preventing catheter-related blood stream infection, but may have the undesirable effect of promoting the emergence of resistant strains of micro-organisms. A policy of prophylactic antibiotic use should take into account this possibility, and has been used as a basis for arguing against its implementation.

Objectives
The primary objective was to assess whether prophylactic antibiotics, in neonates with umbilical venous 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 venous catheters: 1) Among neonates with umbilical venous 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 venous 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 April 2005), CINAHL (1982 to April 2005), the Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library, Issue 1, 2005).

Selection criteria
Randomised controlled trials or quasi-randomised trials in which newborn infants with umbilical venous catheters are randomised to receive prophylactic antibiotics versus placebo or no treatment.

Data collection and analysis

Two reviewers independently assessed trial quality.

Main results
One study, of poor quality, met the criteria for inclusion in this review. Twenty-nine term infants, who had umbilical venous catheters inserted specifically for transfusion procedures for hyperbilirubinaemia or polycythaemia, allocated non-randomly (quasi-randomised - alternate allocation) to treatment (n = 15) or control (n = 14) groups. Those in the treatment group received penicillin and gentamicin for three days. 5/15 infants given antibiotics and 5/14 control infants having positive blood cultures three days after catheter insertion. All positive blood cultures were considered contaminated, due to lack of corroborating clinical and haematological evidence of infection. Therefore, no infants were identified with evidence of septicaemia.

Authors' conclusions
There is insufficient evidence from randomised trials to support or refute the use of prophylactic antibiotics when umbilical venous catheters are inserted in newborn infants. There is no evidence to support or refute continuing antibiotics once initial cultures rule out infection in newborn infants with umbilical venous catheters.

Plain language summary


Prophylactic antibiotics to reduce morbidity and mortality in neonates with umbilical venous catheters
There is insufficient evidence from randomised trials to either support or refute the routine use of preventive antibiotics in newborn babies with umbilical vein catheters. Sick newborn babies occasionally require the insertion of an umbilical vein catheter (a special tube) that goes into the vein in the umbilicus (belly button). This allows fluid and medicines to be given. Some people believe that antibiotics should be given to all babies with umbilical vein catheters in order to reduce the chance of infection occurring. However, antibiotics can have unwanted effects. The reviewers found insufficient evidence to either support or refute the routine use of antibiotics for all babies with umbilical vein catheters.
Keyword Antibiotics
Newborns
Neonates
Morbidity
Mortality
Prophylactic use
Q-Index Code C1
Institutional Status UQ
Additional Notes This record should be cited as: Inglis GDT, Jardine LA, Davies MW. Prophylactic antibiotics to reduce morbidity and mortality in ventilated newborn infants. Cochrane Database of Systematic Reviews 2007, Issue 3. Art. No.: CD004338. DOI: 10.1002/14651858.CD004338.pub3. This version first published online: 26 January 2004 in Issue 1, 2004. Date of most recent substantive amendment: 04 November 2003. Copyright 2006 The Cochrane Collaboration. Reproduced with permission.

Document type: Journal Article
Sub-type: Critical review of research, literature review, critical commentary
Collections: Excellence in Research Australia (ERA) - Collection
UQ Centre for Clinical Research Publications
2006 Higher Education Research Data Collection
 
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Created: Mon, 14 Aug 2006, 10:00:00 EST