Cunningham F G, Leveno K J, DePalma R T, Roark M, Rosenfeld C R
Obstet Gynecol. 1983 Aug;62(2):151-4.
To determine neonatal risk of exposure to intrapartum antimicrobials given to reduce maternal infection following cesarean delivery, 642 mother-infant pairs were evaluated. In 464, the mother was given an initial dose of antimicrobial(s) before cord clamping, whereas in the remaining 178 administration of these drugs was not begun until after delivery. Despite the facts that all infants were at equivalent risk for infection and that none were proved to have bacteremia, 28% of those exposed to intrapartum maternal antimicrobials were evaluated for sepsis whereas only 15% of those not exposed were evaluated (P less than .001). Excess hospital charges for infants in whom sepsis workup was initiated was $127 greater than that for infants not suspected of having sepsis (P less than .025). Of 305 women given three-dose perioperative antimicrobial therapy, 255 were given the initial dose before cord clamping and 24% experienced a subsequent uterine infection. This was not significant when compared with a uterine infection rate of 22% in 50 women in whom three-dose therapy was not initiated until after cord clamping. As maternal benefits that accrue from such intrapartum therapy are equivalent regardless of the timing of three-dose treatment, and as fetal exposure to these drugs has significant clinical and economic impacts, it is concluded that antimicrobials given to these women at high risk should be withheld until after cord clamping.
为确定剖宫产术后给予产妇抗菌药物以降低其感染风险时新生儿暴露于产时抗菌药物的风险，对642对母婴进行了评估。在464对母婴中，母亲在脐带结扎前接受了初始剂量的抗菌药物，而在其余178对母婴中，这些药物直到分娩后才开始使用。尽管所有婴儿感染风险相同且均未被证实有菌血症，但接受产时母亲抗菌药物暴露的婴儿中有28%接受了败血症评估，而未暴露的婴儿中只有15%接受了评估（P<0.001）。启动败血症检查的婴儿的医院费用比未怀疑有败血症的婴儿高出127美元（P<0.025）。在305名接受三剂围手术期抗菌治疗的女性中，255名在脐带结扎前接受了初始剂量，24%随后发生了子宫感染。与50名直到脐带结扎后才开始三剂治疗的女性中22%的子宫感染率相比，这一差异无统计学意义。由于无论三剂治疗的时间如何，这种产时治疗对母亲的益处是相同的，并且由于胎儿接触这些药物会产生重大的临床和经济影响，因此得出结论，对于这些高危女性，应在脐带结扎后再给予抗菌药物。
