Hutzal Carolyn E, Boyle Elaine M, Kenyon Sara L, Nash Jennifer V, Winsor Stephanie, Taylor David J, Kirpalani Haresh
Department of Pediatrics, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada.
Am J Obstet Gynecol. 2008 Dec;199(6):620.e1-8. doi: 10.1016/j.ajog.2008.07.008. Epub 2008 Oct 30.
We conducted a metaanalysis to determine whether antibiotics prolong pregnancy and reduce neonatal morbidity in preterm premature rupture of membranes (PPROM) and preterm labor (PTL) at 34 weeks or less.
Randomized trials comparing antibiotic therapy with placebo in PPROM or PTL at a gestation of 34 weeks or less were retrieved. The primary outcome was time to delivery (latency). Infant outcomes included mortality, infection, neurological abnormality, respiratory disease, and neonatal stay.
Antibiotics were associated with prolongation of pregnancy in PPROM (P < .01) but not PTL. Clinically diagnosed neonatal infections were reduced in both groups; there was a trend toward reduced culture-positive sepsis in PPROM. Intraventricular hemorrhage (all grades) was reduced in PPROM. Other neonatal outcomes were unaffected by antenatal antibiotics.
Antibiotics prolong pregnancy and reduce neonatal morbidity in women with PPROM at a gestation of 34 weeks or less. In PTL at a gestation of 34 weeks or less, there is little evidence of benefit from administration of antibiotics.
我们进行了一项荟萃分析，以确定抗生素是否能延长妊娠时间并降低孕34周及以内胎膜早破（PPROM）和早产（PTL）患者的新生儿发病率。
检索了在孕34周及以内的PPROM或PTL中比较抗生素治疗与安慰剂治疗的随机试验。主要结局是分娩时间（潜伏期）。婴儿结局包括死亡率、感染、神经异常、呼吸系统疾病和新生儿住院时间。
抗生素与PPROM患者的妊娠延长相关（P <.01），但与PTL患者无关。两组临床诊断的新生儿感染均减少；PPROM患者中培养阳性败血症有减少趋势。PPROM患者的脑室内出血（所有级别）减少。其他新生儿结局不受产前抗生素影响。
抗生素可延长孕34周及以内PPROM患者的妊娠时间并降低新生儿发病率。在孕34周及以内的PTL患者中，几乎没有证据表明使用抗生素有益。
