Cooper William O, Ray Wayne A, Griffin Marie R
Division of General Pediatrics, Department of Pediatrics, Vanderbilt University, Nashville, Tennessee 37232-8555, USA.
Obstet Gynecol. 2002 Jul;100(1):101-6. doi: 10.1016/s0029-7844(02)02001-x.
To assess the association between prenatal antibiotics, including erythromycin, and infantile hypertrophic pyloric stenosis in a large cohort of infants.
This was a retrospective cohort study of births to women enrolled in Tennessee Medicaid/TennCare, 1985-1997. Prescriptions for erythromycin, nonerythromycin macrolides, and other antibiotics were identified from pharmacy files linked with birth certificate files. The primary study outcome was development of pyloric stenosis in the infant, identified from linked hospital discharge diagnosis and surgical procedure codes.
The cohort included 260,799 mother/infant pairs. Among these women, 13,146 filled prescriptions for erythromycin (50.4 per 1000), and 621 filled prescriptions for nonerythromycin macrolides (2.4 per 1000). There was no association with prenatal erythromycin prescription and infantile hypertrophic pyloric stenosis either after 32 weeks' gestation (adjusted odds ratio 1.17, 95% confidence interval, 0.84, 1.64, P =.33) or at any time during pregnancy (adjusted odds ratio 1.15, 95% confidence interval 0.84, 1.56, P =.36). There was an association between maternal prescriptions for nonerythromycin macrolides and infantile hypertrophic pyloric stenosis (adjusted odds ratio 2.77, 95% confidence interval 1.22, 6.30, P =.01).
The hypothesized association between erythromycin and infantile pyloric stenosis was not seen. Causal inference from the association between prenatal nonerythromycin macrolides and infantile hypertrophic pyloric stenosis is limited by the small number of affected children and the evidence of other differences between users of nonerythromycin macrolides and controls.
在一大群婴儿中评估包括红霉素在内的产前抗生素与婴儿肥厚性幽门狭窄之间的关联。
这是一项对1985 - 1997年参加田纳西医疗补助计划/田纳西医疗保健计划的妇女所生孩子的回顾性队列研究。从与出生证明文件相关联的药房档案中识别出红霉素、非红霉素大环内酯类药物及其他抗生素的处方。主要研究结局是从相关的医院出院诊断和外科手术编码中确定婴儿是否发生幽门狭窄。
该队列包括260,799对母婴。在这些妇女中，13,146人开具了红霉素处方（每1000人中有50.4人），621人开具了非红霉素大环内酯类药物处方（每1000人中有2.4人）。妊娠32周后，产前红霉素处方与婴儿肥厚性幽门狭窄之间无关联（校正比值比为1.17，95%置信区间为0.84, 1.64，P = 0.33），在孕期任何时间均无关联（校正比值比为1.15，95%置信区间为0.84, 1.56，P = 0.36）。母亲非红霉素大环内酯类药物处方与婴儿肥厚性幽门狭窄之间存在关联（校正比值比为2.77，95%置信区间为1.22, 6.30，P = 0.01）。
未发现红霉素与婴儿幽门狭窄之间存在假设的关联。产前非红霉素大环内酯类药物与婴儿肥厚性幽门狭窄之间关联的因果推断受到受影响儿童数量较少以及非红霉素大环内酯类药物使用者与对照组之间其他差异证据的限制。
