Prophylactic antibiotics to reduce morbidity and mortality in ventilated newborn infants.

BACKGROUND

Bacterial colonisation of the respiratory tract is associated with intubation and may increase the risk of acquiring infection. This may prolong the need for mechanical ventilation and increase the risk of chronic lung disease. The use of prophylactic antibiotics has been advocated for all mechanically ventilated newborns in order to reduce the risk of colonisation and acquired infection. Countering this is the possibility that harm may outweigh benefit.

OBJECTIVES

To assess the effects of prophylactic antibiotics in reducing mortality and morbidity in intubated and ventilated newborn infants who are not known to have infection. In separate comparisons, we reviewed two different policies regarding the prophylactic use of antibiotics in intubated, ventilated infants: 1) among babies who are being intubated for mechanical ventilation, a policy of prophylactic antibiotics for the duration of intubation versus placebo or no treatment. 2) among intubated, ventilated babies who had been started on antibiotics at the time of intubation but whose initial cultures to rule our sepsis are negative, a policy of continuing versus discontinuing prophylactic antibiotics.

SEARCH STRATEGY

We searched MEDLINE (January 1966 to May 2003), CINAHL (1982 to May 2003), the Cochrane Central Register of Controlled Trials (The Cochrane Library, Issue 1, 2003), the Cochrane Neonatal Group Specialised Register and reference lists of articles.

SELECTION CRITERIA

Randomised controlled trials of sufficient quality in which mechanically ventilated newborn infants 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 insufficient quality, met the criteria for inclusion in this review.

REVIEWER'S CONCLUSIONS: There is no evidence from randomised trials to support or refute the use of prophylactic antibiotics when commencing mechanical ventilation in newborn infants, or to support or refute continuing antibiotics once initial cultures rule out infection in mechanically ventilated newborn infants.