Institute of Applied Health Research, University of Birmingham, Birmingham, UK
Populations, Evidence and Technologies, Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK.
BMJ. 2022 May 17;377:e069704. doi: 10.1136/bmj-2021-069704.
To investigate the impact on child health up to age 5 years of a policy to use antibiotic prophylaxis for caesarean section before incision compared with after cord clamping.
Observational controlled interrupted time series study.
UK primary and secondary care.
515 945 children born in 2006-18 with linked maternal records and registered with general practices contributing to two UK primary care databases (The Health Improvement Network and Clinical Practice Research Datalink), and 7 147 884 children with linked maternal records in the Hospital Episode Statistics database covering England, of which 3 945 351 were linked to hospitals that reported the year of policy change to administer prophylactic antibiotics for caesarean section before incision rather than after cord clamping.
Fetal exposure to antibiotics shortly before birth (using pre-incision antibiotic policy as proxy) compared with no exposure.
The primary outcomes were incidence rate ratios of asthma and eczema in children born by caesarean section when pre-incision prophylactic antibiotics were recommended compared with those born when antibiotics were administered post-cord clamping, adjusted for temporal changes in the incidence rates in children born vaginally.
Prophylactic antibiotics administered before incision for caesarean section compared with after cord clamping were not associated with a significantly higher risk of asthma (incidence rate ratio 0.91, 95% confidence interval 0.78 to 1.05) or eczema (0.98, 0.94 to 1.03), including asthma and eczema resulting in hospital admission (1.05, 0.99 to 1.11 and 0.96, 0.71 to 1.29, respectively), up to age 5 years.
This study found no evidence of an association between pre-incision prophylactic antibiotic use and risk of asthma and eczema in early childhood in children born by caesarean section.
研究与断脐后使用剖宫产预防性抗生素相比，在切开前使用抗生素对 5 岁以下儿童健康的影响。
观察性对照中断时间序列研究。
英国初级和二级保健。
2006 年至 2018 年间出生的 515945 名与母亲记录相关联并在参与两个英国初级保健数据库（健康改善网络和临床实践研究数据链接）的全科医生处登记的儿童，以及英格兰 7147884 名与母亲记录相关联的儿童，其中 3945351 名与报告改变政策以在切开前而不是断脐后给予剖宫产预防性抗生素的医院相关联。
胎儿在出生前短时间内接触抗生素（使用切开前抗生素政策作为替代）与不接触抗生素相比。
主要结局指标为在推荐切开前预防性使用抗生素的剖宫产儿童与在断脐后使用抗生素的剖宫产儿童中，哮喘和湿疹的发病率比值，同时调整了阴道分娩儿童发病率的时间变化。
与断脐后相比，剖宫产时切开前给予预防性抗生素与哮喘（发病率比值 0.91，95%置信区间 0.78 至 1.05）或湿疹（0.98，0.94 至 1.03）的风险显著增加无关，包括因哮喘和湿疹导致住院的儿童（1.05，0.99 至 1.11 和 0.96，0.71 至 1.29），直到 5 岁。
本研究未发现切开前预防性使用抗生素与剖宫产儿童早期哮喘和湿疹风险之间存在关联的证据。
