Neonatal Sepsis and Prenatal Antibiotics: New Study Investigates
Late-onset sepsis (LOS) in neonates is a serious infection of the blood that occurs seven days after birth. It is a leading cause of neonatal death, especially in premature infants. A recent study investigates the link between LOS and prenatal antibiotics used to prevent infection following preterm premature rupture of membranes (PPROM).
The study, which is posted on the medRxiv* server as a preprint, aims to examine the association between prenatal antibiotic use and the risk of LOS in at-risk premature infants who are receiving breast milk from their mothers.
- The researchers identified a cohort of infants born after PPROM.
- All babies in the cohort received recommended antibiotics.
- The mothers all received antibiotics for the same number of days.
- The neonates were breastfed for the same duration.
- A fivefold increase in the risk of LOS was observed in neonates following prenatal treatment with cephalosporins and other broad-spectrum antibiotics, compared to penicillin use.
- These antibiotics are more active against Escherichia coli (E. coli), which is often found in the gut microbiota of neonates before causing infection.
- No difference in early-onset sepsis was observed.
- A preclinical mouse model showed a fourfold higher risk of fatal LOS with prenatal cephalosporin therapy, associated with reduced levels of IgA in breast milk.
- Human IgA from breast milk was shown to bind to multiple strains of E. coli, including pathogenic strains.
These findings suggest that maternal administration of select antibiotics could limit maternal IgA availability, leading to an increased risk of LOS in infants by allowing for pathogen colonization in the neonatal intestine. With a quarter of all pregnancies using antibiotics and their association with LOS, it is essential to reconsider antibiotic recommendations and their potential impact on infant mortality and neonatal gut dysbiosis.
Based on the study’s findings, it is suggested that better evidence is needed when using broad-spectrum antibiotics in cases without signs of infection. Further studies are required to understand how antibiotics can disrupt the microbiome-immune axis and impact maternal-child health in the long term.
*Important notice: med