The value of routine empiric antibiotic use in neonates born to mothers with prolonged rupture of membranes

Abstract

Background. The routine use of empiric antibiotics in neonates born to mothers with prolonged rupture of membranes (PROM) is controversial.

Objectives. To determine the incidence of probable and proven sepsis in such neonates and identify risk factors for sepsis and their outcomes.

Methods. This was a retrospective chart review conducted at King Edward VIII Hospital over two years. Study participants included 200 neonates and 181 mothers. Data were captured onto Microsoft Excel, collated and analysed using descriptive statistics and comparative data utilising the R Core Team’s R Statistical Computing Software, 2020.

Results. Seven neonates (3.5%) had proven sepsis, 58 (29%) had probable sepsis, and 135 (67.5%) were without sepsis. Two (1.0%) neonates died and 188 (94.0%) received antibiotics. White cell count was normal in all cases without sepsis and abnormal in 65.5% and 28.6% of cases with probable and proven sepsis, respectively. A raised C-reactive protein was observed in only 22.4% and 14.3% of neonates with probable and proven sepsis, respectively. One hundred and sixty-seven (83.5%) mothers had no Group B Streptococcus (GBS) screening. Of those screened, three had GBS infection, but two did not receive antibiotics.

Conclusions. The incidence of sepsis following PROM is low. Identifying neonates at risk is challenging, but the absence of clinical features and normal rapidly obtained supportive laboratory markers of sepsis provides reassurance that antibiotics could be temporarily withheld. Better GBS screening programmes and appropriate antibiotic responses for pregnant women should be implemented rigorously.