Sharma Rishi, Dutta Sourabh, Suri Vanita, Ray Pallab, Priya Mandula Phani
Division of Neonatology, Department of Pediatrics, Postgraduate Institute of Medical Education and Research (PGIMER), Sector 12, Chandigarh, 160012, India.
Department of Obstetrics and Gynecology, PGIMER, Chandigarh, India.
Indian Pediatr. 2025 Aug 6. doi: 10.1007/s13312-025-00133-2.
To examine the association between the duration of intrapartum antibiotic exposure (IAE) and the risk of culture-negative early-onset neonatal sepsis (EONS) and any late-onset neonatal sepsis (LONS) in the first week.
Preterm neonates (≤ 34 weeks) were enrolled into: Group A (no IAE; n = 282), Group B (IAE < 24 h; n = 204) and Group C (IAE ≥ 24 h; n = 84). The risk factors for EONS and LONS were noted and all neonates were followed up for culture-negative EONS (primary outcome). Secondary outcomes included culture-positive EONS, culture-negative and culture-positive LONS, and multidrug-resistant sepsis. A univariable followed by multivariable analysis of risk factors to predict culture-negative EONS and LONS was performed. The cut-off (Youden's index) of IAE associated with various outcomes was determined.
From group A through C, gestation and birth weight declined, and the proportion at risk of EONS increased. Culture-negative EONS incidence increased (9.57% vs. 12.74% vs. 36.90%, respectively, P < 0.001), but its proportion among all EONS did not. Culture-positive LONS incidence declined (P = 0.038). The proportion of culture-negative LONS among all LONS increased (P = 0.024). Threshold values of 13.5 h and 4.5 h were associated with culture-negative EONS and culture-positive LONS in the first week, respectively. However, on adjusted analysis, IAE duration had no association with culture-negative EONS or LONS in the first week.
Duration of IAE is not independently associated with increased incidence of culture-negative EONS or any LONS.
探讨产时抗生素暴露（IAE）持续时间与培养阴性早发型新生儿败血症（EONS）及第一周内任何晚发型新生儿败血症（LONS）风险之间的关联。
将早产新生儿（≤34周）纳入：A组（无IAE；n = 282）、B组（IAE < 24小时；n = 204）和C组（IAE≥24小时；n = 84）。记录EONS和LONS的危险因素，并对所有新生儿进行随访以观察培养阴性EONS（主要结局）。次要结局包括培养阳性EONS、培养阴性和培养阳性LONS以及多重耐药败血症。对预测培养阴性EONS和LONS的危险因素进行单变量分析，随后进行多变量分析。确定与各种结局相关的IAE的临界值（约登指数）。
从A组到C组，孕周和出生体重下降，EONS风险比例增加。培养阴性EONS发病率增加（分别为9.57%、12.74%和36.90%，P < 0.001），但其在所有EONS中的比例未增加。培养阳性LONS发病率下降（P = 0.038）。培养阴性LONS在所有LONS中的比例增加（P = 0.024）。13.5小时和4.5小时的临界值分别与第一周内培养阴性EONS和培养阳性LONS相关。然而，经校正分析，IAE持续时间与第一周内培养阴性EONS或LONS无关联。
IAE持续时间与培养阴性EONS或任何LONS的发病率增加无独立关联。
