Think your baby will automatically be given antibiotics if you have a C-section? A recent study out of Children’s Hospital of Philadelphia (CHOP) finds that infants shouldn’t need them at birth so long as the delivery was uncomplicated. The move comes to try to avoid giving infants antibiotics if they don’t need them—with the end goal of better protecting infants’ microbiomes in the long run.

An uncomplicated C-section delivery is defined as one without labor or membrane rupture prior to delivery and no concerns about infection.

The 2022 study was published in Pediatrics.

“Our study shows that it is safe to withhold antibiotics in infants, including those born preterm, with low-risk delivery characteristics. Such infants are unlikely to be infected at birth, and can be spared the potential complications of systemic antibiotic exposure, Dustin D. Flannery, DO, an attending neonatologist and clinical researcher at CHOP, said in a statement.

Newborns and antibiotics

Infants are often given antibiotics right after C-section delivery due to the risks associated with early-onset sepsis (EOS). EOS, an infection of the bloodstream or cerebrospinal fluid, can occur within 72 hours of birth. But it’s hard to tell which babies will develop EOS.

About 400,000 uninfected term newborns receive antibiotics intravenously upon birth every year, and upwards of 90% of extremely preterm infants receive antibiotics, Dr. Flannery notes.

Depending on the antibiotics used, repeated doses may be required. Some hospitals require infants to be admitted to the neonatal intensive care unit for antibiotics, while other hospitals may be able to keep infants in the mother's room while receiving treatment, Dr. Flannery tells Motherly

Giving newborns antibiotics has led to a higher rate of antibiotic use compared to the rate of infants with confirmed infection, the researchers say. Newborns who receive antibiotics on a prolonged basis are linked to having serious adverse outcomes among preterm babies, and potentially longstanding complications if they are full-term infants.

Evaluating risk

Because newborns are primarily exposed to bacteria during delivery, the research team assessed delivery characteristics to see if they could identify which infants were at the lowest risk and therefore wouldn’t need the medication.

They looked at all infants born at two Philadelphia hospitals in the same health system between 2009 and 2014. The babies had a blood or cerebrospinal fluid culture within 72 hours after birth.

The researchers evaluated data from 7,549 infants born at various gestational ages. (Previous studies looked at the EOS risk in pre-term (born before 28 weeks) and full-term babies (born after 37 weeks), but few looked at the risk in late and moderately preterm infants (28-36 weeks’ gestation). The latter group makes up most admissions in the neonatal intensive care unit (NICU).

Of the 7,549 infants, 41 had EOS and 14.8% had low-risk deliveries. None of the babies with EOS experienced “low-risk” deliveries, but 80% of them were given antibiotics.

Researchers looked at their medical records to identify confirmed infections and delivery characteristics. They defined low risk C-sections as those without:

  • Rupture of amniotic membranes prior to delivery
  • Labor or attempts to induce labor
  • Suspected or confirmed maternal intraamniotic infection or fetal distress 

Dr. Flannery says the findings show that many infants should not need antibiotics. Instead of automatically doling them out, doctors can use delivery characteristics as a guide to prevent unnecessary antibiotic use and avoid potential complications.

​Changing the standard?

Dr. Flannery says the American​ Academy of Pediatrics (AAP) Committee on the Fetus and Newborn (COFN) makes recommendations about antibiotic treatment for newborns.

AAP’s most recent 2018 guidelines on managing suspected early-onset sepsis support not giving antibiotics to preterm infants born in low-risk deliveries. They also published guidance that year on term and late-term infants, but it does not specifically address the low-risk C-section scenario. 

“The study we recently published in Pediatrics was designed to address this question among older gestation infants, and the results may potentially be considered in future revisions of the AAP guidance,” Karen M. Puopolo, MD, an author on the 2022 study, tells Motherly.

Dr. Flannery says he also believes the AAP will take the 2022 study into consideration when updating guidelines in the future.

Sources

Flannery DD, Mukhopadhyay S, Morales KH, Dhudasia MB, Passarella M, Gerber JS, Puopolo KM. Delivery characteristics and the risk of early-onset neonatal sepsis. Pediatrics. 2022 Jan 12. doi:10.1542/peds.2021-052900

Puopolo KM, Benitz WE, Zaoutis TE, Cummings J, Juul S, Hand I, Eichenwald E, Poindexter B, Stewart DL, Aucott SW, Goldsmith JP. Management of neonates born at≤ 34 6/7 weeks’ gestation with suspected or proven early-onset bacterial sepsis. Pediatrics. 2018 Dec 1;142(6). doi:10.1542/peds.2018-2896

Puopolo KM, Benitz WE, Zaoutis TE, Cummings J, Juul S, Hand I, Eichenwald E, Poindexter B, Stewart DL, Aucott SW, Goldsmith JP. Management of neonates born at≥ 35 0/7 weeks’ gestation with suspected or proven early-onset bacterial sepsis. Pediatrics. 2018 Dec 1;142(6). doi:10.1542/peds.2018-2894

Featured Experts

​​Dustin D. Flannery, DO, MSCE, is an attending neonatologist at CHOP Newborn Care at Pennsylvania Hospital.

Karen Puopolo, MD, PhD, is an attending neonatologist and Chief of the Section on Newborn Medicine at Pennsylvania Hospital.