Berardi Alberto, Pietrangiolillo Zaira, Bacchi Reggiani Maria Letizia, Bianco Valentina, Gallesi Daniela, Rossi Katia, Facchinetti Fabio, Ferrari Fabrizio
Unit Operativa di Terapia Intensiva Neonatale, Dipartimento Integrato Materno Infantile, Azienda Ospedaliero-Universitaria Policlinico, Modena, Italy.
Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale, Azienda Ospedaliero-Universitaria S.Orsola-Malpighi, Bologna, Italy.
Arch Dis Child Fetal Neonatal Ed. 2018 Mar;103(2):F152-F156. doi: 10.1136/archdischild-2016-312546. Epub 2017 Jun 29.
To assess ampicillin levels according to the duration of intrapartum antibiotic prophylaxis (IAP).
Prospective cohort single-centre study.
Tertiary care centre (Modena, Italy).
120 neonates≥35 weeks' gestation exposed to IAP.
Neonates were divided into four groups, according to the duration of IAP prior to delivery: group 1 (n=30; <1 hour), group 2 (n=30; ≥1 and <2 hours), group 3 (n=30; ≥2 and <4 hours) and group 4 (n=30; ≥2 doses, ≥4 hours).
Blood samples were collected at delivery (from the umbilical cord) and at age 4 hours (from a peripheral vessel).
Median duration of IAP was 121 min (range 7-2045 min). Median ampicillin levels in umbilical cord blood were 10.4 µg/mL (IQR 6.4-14.9) and in peripheral blood were 4.7 µg/mL (IQR 2.8-6.4µg/mL). Umbilical cord blood levels reached a peak approximately 30 min after IAP and then declined significantly (p<0.001). Peripheral blood levels did not differ among study groups. Neonates exposed to a full loading dose (n=115) had peripheral blood levels 2.5-70 times higher than the minimal inhibitory concentration for group B streptococcus. There was no relationship between neonatal ampicillin concentrations and the duration of IAP prior to delivery (β=-0.0003, 95% CI -0.02 to 0.001, p=0.680).
Ampicillin levels reach a peak in the umbilical cord blood within 30 min of intrapartum administration. After a full loading dose, bactericidal levels persist for at least 4 hours after birth and seem independent of the duration of IAP prior to delivery.
根据产时抗生素预防性应用（IAP）的持续时间评估氨苄西林水平。
前瞻性队列单中心研究。
三级医疗中心（意大利摩德纳）。
120例孕周≥35周且接受IAP的新生儿。
根据分娩前IAP的持续时间将新生儿分为四组：第1组（n = 30；<1小时），第2组（n = 30；≥1且<2小时），第3组（n = 30；≥2且<4小时）和第4组（n = 30；≥2剂，≥4小时）。
在分娩时（从脐带采集）和出生4小时时（从外周血管采集）采集血样。
IAP的中位持续时间为121分钟（范围7 - 2045分钟）。脐带血中氨苄西林的中位水平为10.4μg/mL（四分位间距6.4 - 14.9），外周血中为4.7μg/mL（四分位间距2.8 - 6.4μg/mL）。脐带血水平在IAP后约30分钟达到峰值，然后显著下降（p<0.001）。各研究组之间外周血水平无差异。接受足量负荷剂量的新生儿（n = 115）外周血水平比B族链球菌的最低抑菌浓度高2.5 - 70倍。新生儿氨苄西林浓度与分娩前IAP的持续时间之间无相关性（β = -0.0003，95%可信区间 -0.02至0.001，p = 0.680）。
产时给予氨苄西林后30分钟内脐带血中氨苄西林水平达到峰值。给予足量负荷剂量后，杀菌水平在出生后至少持续4小时，且似乎与分娩前IAP的持续时间无关。
