Scolaris Content Display Scolaris Content Display

Cochrane Database of Systematic Reviews

Antibióticos profilácticos para la inhibición del trabajo de parto prematuro con membranas intactas

Información

DOI:
https://doi.org/10.1002/14651858.CD000246.pub2Copiar DOI
Base de datos:
  1. Cochrane Database of Systematic Reviews
Versión publicada:
  1. 05 diciembre 2013see what's new
Tipo:
  1. Intervention
Etapa:
  1. Review
Grupo Editorial Cochrane:
  1. Grupo Cochrane de Embarazo y parto

Copyright:
  1. Copyright © 2013 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.

Cifras del artículo

Altmetric:

Citado por:

Citado 0 veces por enlace Crossref Cited-by

Contraer

Autores

  • Vicki Flenady

    Correspondencia a: Translating Research Into Practice (TRIP) Centre ‐ Mater Research, Mater Health Services, Woolloongabba, Australia

    [email protected]

  • Glenda Hawley

    Mater Medical Research Institute, Mater Health Services, Wooloongabba, Australia

  • Owen M Stock

    Department of Obstetrics and Gynaecology, Mater Mothers' Hospital, Mater Health Services, Brisbane, Australia

  • Sara Kenyon

    School of Health and Population Sciences, University of Birmingham, Edgbaston, UK

  • Nadia Badawi

    Grace Centre for Newborn Care, The Children's Hospital at Westmead, Sydney, Australia

Contributions of authors

Vicki Flenady compiled the review in consultation with co‐authors. Glenda Halwey worked with Vicki Flenady to assess studies for inclusion and extract data. Owen Stock extracted information on the new studies for this update, assisted in interpretation of the results and editing the review. Nadia Badawi assisted with interpretation of the results. Sara Kenyon provided information on study characteristics of the ORACLE trial and follow‐up study, assisted in interpretation of the findings and editing the review. All authors commented on drafts of the review and approved the final version before submission.

Sources of support

Internal sources

  • Department of Perinatal Medicine, Royal Women's Hospital, Melbourne, Victoria, Australia.

  • Mater Medical Research Institute, Sth Brisbane, Queensland, Australia.

External sources

  • Commonwealth Department of Health and Ageing, Canberra, Australian Capital Territory, Australia.

Declarations of interest

Sara Kenyon led the ORACLE trial and was the CI for the ORACLE Children's Study.

Acknowledgements

We would like to thank Staffan Bergstrom, Susan Cox, Janice French, John Morrison, Karin Norman, Roberto Romero, Jens Svare and Elizabeth Thom and Heather Watts for assistance in providing unpublished data from their clinical trials and for clarifications of other queries.

We would like to acknowledge Linda Murray who assisted with reference management, correspondence and editing in the previous version of the review. We thank James King for his guidance in leading the previous version of this review and Philippa Middleton for advice.

As part of the pre‐publication editorial process, this review has been commented on by three peers (an editor and two referees who are external to the editorial team) and the Group's Statistical Adviser.

The National Institute for Health Research (NIHR) is the largest single funder of the Cochrane Pregnancy and Childbirth Group. The views and opinions expressed therein are those of the authors and do not necessarily reflect those of the NIHR, NHS or the Department of Health.

Version history

Published

Title

Stage

Authors

Version

2013 Dec 05

Prophylactic antibiotics for inhibiting preterm labour with intact membranes

Review

Vicki Flenady, Glenda Hawley, Owen M Stock, Sara Kenyon, Nadia Badawi

https://doi.org/10.1002/14651858.CD000246.pub2

2002 Oct 21

Prophylactic antibiotics for inhibiting preterm labour with intact membranes

Review

James F King, Vicki Flenady, Linda Murray

https://doi.org/10.1002/14651858.CD000246

Differences between protocol and review

In this update October 2013, primary and secondary outcomes have been defined. Additional outcomes measures are included as primary outcomes. These are: serious maternal adverse outcome related to antibiotic treatment (respiratory arrest, cardiac arrest, death) and a composite measure of death (fetal, neonatal, or later death up to the time of follow‐up) or major long‐term infant neurosensory impairment. Further, the list of outcomes measures included in subgroup analyses are now restricted to those which are considered to be most clinically important. Two additional comparisons were included: Any macrolide antibiotics versus No macrolide antibiotics; and Any beta‐lactam antibiotics versus No beta‐lactam antibiotics. We also removed the exclusion criterion according to attrition rates.

Keywords

MeSH

PICO

Population
Intervention
Comparison
Outcome

El uso y la enseñanza del modelo PICO están muy extendidos en el ámbito de la atención sanitaria basada en la evidencia para formular preguntas y estrategias de búsqueda y para caracterizar estudios o metanálisis clínicos. PICO son las siglas en inglés de cuatro posibles componentes de una pregunta de investigación: paciente, población o problema; intervención; comparación; desenlace (outcome).

Para saber más sobre el uso del modelo PICO, puede consultar el Manual Cochrane.

'Risk of bias' graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.
Figuras y tablas -
Figure 1

'Risk of bias' graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.

'Risk of bias' summary: review authors' judgements about each risk of bias item for each included study.
Figuras y tablas -
Figure 2

'Risk of bias' summary: review authors' judgements about each risk of bias item for each included study.

Funnel plot of comparison: 1 Any antibiotics versus no antibiotics, outcome: 1.1 Perinatal mortality.
Figuras y tablas -
Figure 3

Funnel plot of comparison: 1 Any antibiotics versus no antibiotics, outcome: 1.1 Perinatal mortality.

Funnel plot of comparison: 1 Any antibiotics versus no antibiotics, outcome: 1.12 Preterm birth (< 36 or < 37 weeks).
Figuras y tablas -
Figure 4

Funnel plot of comparison: 1 Any antibiotics versus no antibiotics, outcome: 1.12 Preterm birth (< 36 or < 37 weeks).

Funnel plot of comparison: 1 Any antibiotics versus no antibiotics, outcome: 1.20 Neonatal sepsis.
Figuras y tablas -
Figure 5

Funnel plot of comparison: 1 Any antibiotics versus no antibiotics, outcome: 1.20 Neonatal sepsis.

Funnel plot of comparison: 1 Any antibiotics versus no antibiotics, outcome: 1.9 Maternal infection.
Figuras y tablas -
Figure 6

Funnel plot of comparison: 1 Any antibiotics versus no antibiotics, outcome: 1.9 Maternal infection.

Comparison 1 Any antibiotics versus no antibiotics, Outcome 1 Perinatal mortality.
Figuras y tablas -
Analysis 1.1

Comparison 1 Any antibiotics versus no antibiotics, Outcome 1 Perinatal mortality.

Comparison 1 Any antibiotics versus no antibiotics, Outcome 2 Stillbirth.
Figuras y tablas -
Analysis 1.2

Comparison 1 Any antibiotics versus no antibiotics, Outcome 2 Stillbirth.

Comparison 1 Any antibiotics versus no antibiotics, Outcome 3 Neonatal death.
Figuras y tablas -
Analysis 1.3

Comparison 1 Any antibiotics versus no antibiotics, Outcome 3 Neonatal death.

Comparison 1 Any antibiotics versus no antibiotics, Outcome 4 Infant death.
Figuras y tablas -
Analysis 1.4

Comparison 1 Any antibiotics versus no antibiotics, Outcome 4 Infant death.

Comparison 1 Any antibiotics versus no antibiotics, Outcome 5 Any functional impairment at 7 years of age..
Figuras y tablas -
Analysis 1.5

Comparison 1 Any antibiotics versus no antibiotics, Outcome 5 Any functional impairment at 7 years of age..

Comparison 1 Any antibiotics versus no antibiotics, Outcome 6 Moderate/severe functional impairment at 7 years of age..
Figuras y tablas -
Analysis 1.6

Comparison 1 Any antibiotics versus no antibiotics, Outcome 6 Moderate/severe functional impairment at 7 years of age..

Comparison 1 Any antibiotics versus no antibiotics, Outcome 7 Cerebral palsy at 7 years.
Figuras y tablas -
Analysis 1.7

Comparison 1 Any antibiotics versus no antibiotics, Outcome 7 Cerebral palsy at 7 years.

Comparison 1 Any antibiotics versus no antibiotics, Outcome 8 Maternal adverse drug reaction requiring cessation of treatment.
Figuras y tablas -
Analysis 1.8

Comparison 1 Any antibiotics versus no antibiotics, Outcome 8 Maternal adverse drug reaction requiring cessation of treatment.

Comparison 1 Any antibiotics versus no antibiotics, Outcome 9 Maternal infection.
Figuras y tablas -
Analysis 1.9

Comparison 1 Any antibiotics versus no antibiotics, Outcome 9 Maternal infection.

Comparison 1 Any antibiotics versus no antibiotics, Outcome 10 Delay in birth (subgrouped by interval).
Figuras y tablas -
Analysis 1.10

Comparison 1 Any antibiotics versus no antibiotics, Outcome 10 Delay in birth (subgrouped by interval).

Comparison 1 Any antibiotics versus no antibiotics, Outcome 11 Interval between randomisation and birth (days).
Figuras y tablas -
Analysis 1.11

Comparison 1 Any antibiotics versus no antibiotics, Outcome 11 Interval between randomisation and birth (days).

Comparison 1 Any antibiotics versus no antibiotics, Outcome 12 Preterm birth (< 36 or < 37 weeks).
Figuras y tablas -
Analysis 1.12

Comparison 1 Any antibiotics versus no antibiotics, Outcome 12 Preterm birth (< 36 or < 37 weeks).

Comparison 1 Any antibiotics versus no antibiotics, Outcome 13 Gestational age at birth.
Figuras y tablas -
Analysis 1.13

Comparison 1 Any antibiotics versus no antibiotics, Outcome 13 Gestational age at birth.

Comparison 1 Any antibiotics versus no antibiotics, Outcome 14 Birthweight.
Figuras y tablas -
Analysis 1.14

Comparison 1 Any antibiotics versus no antibiotics, Outcome 14 Birthweight.

Comparison 1 Any antibiotics versus no antibiotics, Outcome 15 Birthweight < 2500 g.
Figuras y tablas -
Analysis 1.15

Comparison 1 Any antibiotics versus no antibiotics, Outcome 15 Birthweight < 2500 g.

Comparison 1 Any antibiotics versus no antibiotics, Outcome 16 Admission to neonatal intensive or special care nursery.
Figuras y tablas -
Analysis 1.16

Comparison 1 Any antibiotics versus no antibiotics, Outcome 16 Admission to neonatal intensive or special care nursery.

Comparison 1 Any antibiotics versus no antibiotics, Outcome 17 Neonatal mechanical ventilation.
Figuras y tablas -
Analysis 1.17

Comparison 1 Any antibiotics versus no antibiotics, Outcome 17 Neonatal mechanical ventilation.

Comparison 1 Any antibiotics versus no antibiotics, Outcome 18 Respiratory distress syndrome.
Figuras y tablas -
Analysis 1.18

Comparison 1 Any antibiotics versus no antibiotics, Outcome 18 Respiratory distress syndrome.

Comparison 1 Any antibiotics versus no antibiotics, Outcome 19 Neonatal positive blood culture.
Figuras y tablas -
Analysis 1.19

Comparison 1 Any antibiotics versus no antibiotics, Outcome 19 Neonatal positive blood culture.

Comparison 1 Any antibiotics versus no antibiotics, Outcome 20 Neonatal sepsis.
Figuras y tablas -
Analysis 1.20

Comparison 1 Any antibiotics versus no antibiotics, Outcome 20 Neonatal sepsis.

Comparison 1 Any antibiotics versus no antibiotics, Outcome 21 Intraventricular haemorrhage.
Figuras y tablas -
Analysis 1.21

Comparison 1 Any antibiotics versus no antibiotics, Outcome 21 Intraventricular haemorrhage.

Comparison 1 Any antibiotics versus no antibiotics, Outcome 22 Necrotising enterocolitis.
Figuras y tablas -
Analysis 1.22

Comparison 1 Any antibiotics versus no antibiotics, Outcome 22 Necrotising enterocolitis.

Comparison 1 Any antibiotics versus no antibiotics, Outcome 23 Major cerebral abnormality.
Figuras y tablas -
Analysis 1.23

Comparison 1 Any antibiotics versus no antibiotics, Outcome 23 Major cerebral abnormality.

Comparison 1 Any antibiotics versus no antibiotics, Outcome 24 Chronic neonatal lung disease.
Figuras y tablas -
Analysis 1.24

Comparison 1 Any antibiotics versus no antibiotics, Outcome 24 Chronic neonatal lung disease.

Comparison 2 Antibiotics versus no antibiotics (subgrouped by type of antibiotic), Outcome 1 Perinatal mortality.
Figuras y tablas -
Analysis 2.1

Comparison 2 Antibiotics versus no antibiotics (subgrouped by type of antibiotic), Outcome 1 Perinatal mortality.

Comparison 2 Antibiotics versus no antibiotics (subgrouped by type of antibiotic), Outcome 2 Stillbirth.
Figuras y tablas -
Analysis 2.2

Comparison 2 Antibiotics versus no antibiotics (subgrouped by type of antibiotic), Outcome 2 Stillbirth.

Comparison 2 Antibiotics versus no antibiotics (subgrouped by type of antibiotic), Outcome 3 Neonatal death.
Figuras y tablas -
Analysis 2.3

Comparison 2 Antibiotics versus no antibiotics (subgrouped by type of antibiotic), Outcome 3 Neonatal death.

Comparison 2 Antibiotics versus no antibiotics (subgrouped by type of antibiotic), Outcome 4 Infant death.
Figuras y tablas -
Analysis 2.4

Comparison 2 Antibiotics versus no antibiotics (subgrouped by type of antibiotic), Outcome 4 Infant death.

Comparison 2 Antibiotics versus no antibiotics (subgrouped by type of antibiotic), Outcome 5 Any functional impairment at 7 years of age..
Figuras y tablas -
Analysis 2.5

Comparison 2 Antibiotics versus no antibiotics (subgrouped by type of antibiotic), Outcome 5 Any functional impairment at 7 years of age..

Comparison 2 Antibiotics versus no antibiotics (subgrouped by type of antibiotic), Outcome 6 Moderate/severe functional impairment at 7 years of age..
Figuras y tablas -
Analysis 2.6

Comparison 2 Antibiotics versus no antibiotics (subgrouped by type of antibiotic), Outcome 6 Moderate/severe functional impairment at 7 years of age..

Comparison 2 Antibiotics versus no antibiotics (subgrouped by type of antibiotic), Outcome 7 Cerebral palsy at 7 years of age.
Figuras y tablas -
Analysis 2.7

Comparison 2 Antibiotics versus no antibiotics (subgrouped by type of antibiotic), Outcome 7 Cerebral palsy at 7 years of age.

Comparison 2 Antibiotics versus no antibiotics (subgrouped by type of antibiotic), Outcome 8 Maternal adverse drug reaction requiring cessation of treatment.
Figuras y tablas -
Analysis 2.8

Comparison 2 Antibiotics versus no antibiotics (subgrouped by type of antibiotic), Outcome 8 Maternal adverse drug reaction requiring cessation of treatment.

Comparison 2 Antibiotics versus no antibiotics (subgrouped by type of antibiotic), Outcome 9 Maternal infection.
Figuras y tablas -
Analysis 2.9

Comparison 2 Antibiotics versus no antibiotics (subgrouped by type of antibiotic), Outcome 9 Maternal infection.

Comparison 2 Antibiotics versus no antibiotics (subgrouped by type of antibiotic), Outcome 10 Birth within 48 hours of randomisation.
Figuras y tablas -
Analysis 2.10

Comparison 2 Antibiotics versus no antibiotics (subgrouped by type of antibiotic), Outcome 10 Birth within 48 hours of randomisation.

Comparison 2 Antibiotics versus no antibiotics (subgrouped by type of antibiotic), Outcome 11 Interval between randomisation and birth (days).
Figuras y tablas -
Analysis 2.11

Comparison 2 Antibiotics versus no antibiotics (subgrouped by type of antibiotic), Outcome 11 Interval between randomisation and birth (days).

Comparison 2 Antibiotics versus no antibiotics (subgrouped by type of antibiotic), Outcome 12 Preterm birth (< 36 or < 37 weeks' gestation).
Figuras y tablas -
Analysis 2.12

Comparison 2 Antibiotics versus no antibiotics (subgrouped by type of antibiotic), Outcome 12 Preterm birth (< 36 or < 37 weeks' gestation).

Comparison 2 Antibiotics versus no antibiotics (subgrouped by type of antibiotic), Outcome 13 Respiratory distress syndrome.
Figuras y tablas -
Analysis 2.13

Comparison 2 Antibiotics versus no antibiotics (subgrouped by type of antibiotic), Outcome 13 Respiratory distress syndrome.

Comparison 2 Antibiotics versus no antibiotics (subgrouped by type of antibiotic), Outcome 14 Necrotising enterocolitis.
Figuras y tablas -
Analysis 2.14

Comparison 2 Antibiotics versus no antibiotics (subgrouped by type of antibiotic), Outcome 14 Necrotising enterocolitis.

Comparison 2 Antibiotics versus no antibiotics (subgrouped by type of antibiotic), Outcome 15 Intraventricular haemorrhage.
Figuras y tablas -
Analysis 2.15

Comparison 2 Antibiotics versus no antibiotics (subgrouped by type of antibiotic), Outcome 15 Intraventricular haemorrhage.

Comparison 3 Any macrolide versus no macrolide, Outcome 1 Perinatal mortality.
Figuras y tablas -
Analysis 3.1

Comparison 3 Any macrolide versus no macrolide, Outcome 1 Perinatal mortality.

Comparison 3 Any macrolide versus no macrolide, Outcome 2 Stillbirth.
Figuras y tablas -
Analysis 3.2

Comparison 3 Any macrolide versus no macrolide, Outcome 2 Stillbirth.

Comparison 3 Any macrolide versus no macrolide, Outcome 3 Neonatal death.
Figuras y tablas -
Analysis 3.3

Comparison 3 Any macrolide versus no macrolide, Outcome 3 Neonatal death.

Comparison 3 Any macrolide versus no macrolide, Outcome 4 Infant death.
Figuras y tablas -
Analysis 3.4

Comparison 3 Any macrolide versus no macrolide, Outcome 4 Infant death.

Comparison 3 Any macrolide versus no macrolide, Outcome 5 Any functional impairment at 7 years of age..
Figuras y tablas -
Analysis 3.5

Comparison 3 Any macrolide versus no macrolide, Outcome 5 Any functional impairment at 7 years of age..

Comparison 3 Any macrolide versus no macrolide, Outcome 6 Moderate/severe functional impairment at 7 years of age..
Figuras y tablas -
Analysis 3.6

Comparison 3 Any macrolide versus no macrolide, Outcome 6 Moderate/severe functional impairment at 7 years of age..

Comparison 3 Any macrolide versus no macrolide, Outcome 7 Cerebral palsy at 7 years.
Figuras y tablas -
Analysis 3.7

Comparison 3 Any macrolide versus no macrolide, Outcome 7 Cerebral palsy at 7 years.

Comparison 3 Any macrolide versus no macrolide, Outcome 8 Maternal adverse drug reaction requiring cessation of treatment.
Figuras y tablas -
Analysis 3.8

Comparison 3 Any macrolide versus no macrolide, Outcome 8 Maternal adverse drug reaction requiring cessation of treatment.

Comparison 3 Any macrolide versus no macrolide, Outcome 9 Maternal infection.
Figuras y tablas -
Analysis 3.9

Comparison 3 Any macrolide versus no macrolide, Outcome 9 Maternal infection.

Comparison 3 Any macrolide versus no macrolide, Outcome 10 Birth within 48 hours of randomisation.
Figuras y tablas -
Analysis 3.10

Comparison 3 Any macrolide versus no macrolide, Outcome 10 Birth within 48 hours of randomisation.

Comparison 3 Any macrolide versus no macrolide, Outcome 11 Interval between randomisation and birth (days).
Figuras y tablas -
Analysis 3.11

Comparison 3 Any macrolide versus no macrolide, Outcome 11 Interval between randomisation and birth (days).

Comparison 3 Any macrolide versus no macrolide, Outcome 12 Preterm birth (< 36 or < 37 weeks).
Figuras y tablas -
Analysis 3.12

Comparison 3 Any macrolide versus no macrolide, Outcome 12 Preterm birth (< 36 or < 37 weeks).

Comparison 3 Any macrolide versus no macrolide, Outcome 13 Respiratory distress syndrome.
Figuras y tablas -
Analysis 3.13

Comparison 3 Any macrolide versus no macrolide, Outcome 13 Respiratory distress syndrome.

Comparison 3 Any macrolide versus no macrolide, Outcome 14 Intraventricular haemorrhage.
Figuras y tablas -
Analysis 3.14

Comparison 3 Any macrolide versus no macrolide, Outcome 14 Intraventricular haemorrhage.

Comparison 3 Any macrolide versus no macrolide, Outcome 15 Necrotising enterocolitis.
Figuras y tablas -
Analysis 3.15

Comparison 3 Any macrolide versus no macrolide, Outcome 15 Necrotising enterocolitis.

Comparison 4 Any beta‐lactam versus no beta‐lactam, Outcome 1 Perinatal mortality.
Figuras y tablas -
Analysis 4.1

Comparison 4 Any beta‐lactam versus no beta‐lactam, Outcome 1 Perinatal mortality.

Comparison 4 Any beta‐lactam versus no beta‐lactam, Outcome 2 Stillbirth.
Figuras y tablas -
Analysis 4.2

Comparison 4 Any beta‐lactam versus no beta‐lactam, Outcome 2 Stillbirth.

Comparison 4 Any beta‐lactam versus no beta‐lactam, Outcome 3 Neonatal death.
Figuras y tablas -
Analysis 4.3

Comparison 4 Any beta‐lactam versus no beta‐lactam, Outcome 3 Neonatal death.

Comparison 4 Any beta‐lactam versus no beta‐lactam, Outcome 4 Infant death.
Figuras y tablas -
Analysis 4.4

Comparison 4 Any beta‐lactam versus no beta‐lactam, Outcome 4 Infant death.

Comparison 4 Any beta‐lactam versus no beta‐lactam, Outcome 5 Any functional impairment at 7 years of age..
Figuras y tablas -
Analysis 4.5

Comparison 4 Any beta‐lactam versus no beta‐lactam, Outcome 5 Any functional impairment at 7 years of age..

Comparison 4 Any beta‐lactam versus no beta‐lactam, Outcome 6 Moderate/severe functional impairment at 7 years of age..
Figuras y tablas -
Analysis 4.6

Comparison 4 Any beta‐lactam versus no beta‐lactam, Outcome 6 Moderate/severe functional impairment at 7 years of age..

Comparison 4 Any beta‐lactam versus no beta‐lactam, Outcome 7 Cerebral palsy at 7 years.
Figuras y tablas -
Analysis 4.7

Comparison 4 Any beta‐lactam versus no beta‐lactam, Outcome 7 Cerebral palsy at 7 years.

Comparison 4 Any beta‐lactam versus no beta‐lactam, Outcome 8 Maternal adverse drug reaction requiring cessation of treatment.
Figuras y tablas -
Analysis 4.8

Comparison 4 Any beta‐lactam versus no beta‐lactam, Outcome 8 Maternal adverse drug reaction requiring cessation of treatment.

Comparison 4 Any beta‐lactam versus no beta‐lactam, Outcome 9 Maternal infection.
Figuras y tablas -
Analysis 4.9

Comparison 4 Any beta‐lactam versus no beta‐lactam, Outcome 9 Maternal infection.

Comparison 4 Any beta‐lactam versus no beta‐lactam, Outcome 10 Birth within 48 hours of randomisation.
Figuras y tablas -
Analysis 4.10

Comparison 4 Any beta‐lactam versus no beta‐lactam, Outcome 10 Birth within 48 hours of randomisation.

Comparison 4 Any beta‐lactam versus no beta‐lactam, Outcome 11 Interval between randomisation and birth (days).
Figuras y tablas -
Analysis 4.11

Comparison 4 Any beta‐lactam versus no beta‐lactam, Outcome 11 Interval between randomisation and birth (days).

Comparison 4 Any beta‐lactam versus no beta‐lactam, Outcome 12 Preterm birth (< 36 or < 37 weeks).
Figuras y tablas -
Analysis 4.12

Comparison 4 Any beta‐lactam versus no beta‐lactam, Outcome 12 Preterm birth (< 36 or < 37 weeks).

Comparison 4 Any beta‐lactam versus no beta‐lactam, Outcome 13 Respiratory distress syndrome.
Figuras y tablas -
Analysis 4.13

Comparison 4 Any beta‐lactam versus no beta‐lactam, Outcome 13 Respiratory distress syndrome.

Comparison 4 Any beta‐lactam versus no beta‐lactam, Outcome 14 Intraventricular haemorrhage.
Figuras y tablas -
Analysis 4.14

Comparison 4 Any beta‐lactam versus no beta‐lactam, Outcome 14 Intraventricular haemorrhage.

Comparison 4 Any beta‐lactam versus no beta‐lactam, Outcome 15 Necrotising enterocolitis.
Figuras y tablas -
Analysis 4.15

Comparison 4 Any beta‐lactam versus no beta‐lactam, Outcome 15 Necrotising enterocolitis.

Comparison 1. Any antibiotics versus no antibiotics

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Perinatal mortality Show forest plot

10

7304

Risk Ratio (M‐H, Fixed, 95% CI)

1.22 [0.88, 1.69]

2 Stillbirth Show forest plot

8

7080

Risk Ratio (M‐H, Fixed, 95% CI)

0.73 [0.43, 1.26]

3 Neonatal death Show forest plot

9

7248

Risk Ratio (M‐H, Fixed, 95% CI)

1.57 [1.03, 2.40]

4 Infant death Show forest plot

1

4654

Risk Ratio (M‐H, Fixed, 95% CI)

1.06 [0.68, 1.67]

5 Any functional impairment at 7 years of age. Show forest plot

1

3052

Risk Ratio (M‐H, Fixed, 95% CI)

1.10 [0.99, 1.23]

6 Moderate/severe functional impairment at 7 years of age. Show forest plot

1

3052

Risk Ratio (M‐H, Fixed, 95% CI)

1.07 [0.89, 1.28]

7 Cerebral palsy at 7 years Show forest plot

1

3173

Risk Ratio (M‐H, Fixed, 95% CI)

1.82 [0.99, 3.34]

8 Maternal adverse drug reaction requiring cessation of treatment Show forest plot

5

626

Risk Ratio (M‐H, Fixed, 95% CI)

1.32 [0.92, 1.89]

9 Maternal infection Show forest plot

10

7371

Risk Ratio (M‐H, Fixed, 95% CI)

0.74 [0.63, 0.86]

10 Delay in birth (subgrouped by interval) Show forest plot

9

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

10.1 Birth within 48 hours

4

6800

Risk Ratio (M‐H, Fixed, 95% CI)

1.04 [0.89, 1.23]

10.2 Birth within 7 days

8

7053

Risk Ratio (M‐H, Fixed, 95% CI)

0.98 [0.87, 1.10]

11 Interval between randomisation and birth (days) Show forest plot

6

2499

Mean Difference (IV, Random, 95% CI)

5.59 [0.31, 10.87]

12 Preterm birth (< 36 or < 37 weeks) Show forest plot

10

7387

Risk Ratio (M‐H, Fixed, 95% CI)

0.98 [0.92, 1.05]

13 Gestational age at birth Show forest plot

10

986

Mean Difference (IV, Random, 95% CI)

0.53 [0.00, 1.06]

14 Birthweight Show forest plot

12

7531

Mean Difference (IV, Random, 95% CI)

58.38 [‐26.24, 143.00]

15 Birthweight < 2500 g Show forest plot

5

6628

Risk Ratio (M‐H, Random, 95% CI)

0.97 [0.81, 1.15]

16 Admission to neonatal intensive or special care nursery Show forest plot

5

6875

Risk Ratio (M‐H, Random, 95% CI)

0.82 [0.62, 1.10]

17 Neonatal mechanical ventilation Show forest plot

1

6241

Risk Ratio (M‐H, Fixed, 95% CI)

1.02 [0.84, 1.24]

18 Respiratory distress syndrome Show forest plot

9

7200

Risk Ratio (M‐H, Fixed, 95% CI)

0.99 [0.84, 1.16]

19 Neonatal positive blood culture Show forest plot

3

6526

Risk Ratio (M‐H, Fixed, 95% CI)

1.01 [0.69, 1.49]

20 Neonatal sepsis Show forest plot

10

7386

Risk Ratio (M‐H, Fixed, 95% CI)

0.86 [0.64, 1.16]

21 Intraventricular haemorrhage Show forest plot

5

6813

Risk Ratio (M‐H, Fixed, 95% CI)

0.76 [0.48, 1.19]

22 Necrotising enterocolitis Show forest plot

6

6880

Risk Ratio (M‐H, Fixed, 95% CI)

1.06 [0.64, 1.73]

23 Major cerebral abnormality Show forest plot

1

6241

Risk Ratio (M‐H, Fixed, 95% CI)

1.00 [0.66, 1.51]

24 Chronic neonatal lung disease Show forest plot

1

6241

Risk Ratio (M‐H, Fixed, 95% CI)

1.17 [0.78, 1.76]

Figuras y tablas -
Comparison 1. Any antibiotics versus no antibiotics
Comparison 2. Antibiotics versus no antibiotics (subgrouped by type of antibiotic)

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Perinatal mortality Show forest plot

10

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

1.1 Beta‐lactam antibiotics alone vs no antibiotics

4

2323

Risk Ratio (M‐H, Fixed, 95% CI)

1.13 [0.64, 2.01]

1.2 Macrolide antibiotics alone vs no antibiotics

2

2222

Risk Ratio (M‐H, Fixed, 95% CI)

1.17 [0.64, 2.11]

1.3 Macrolide and beta‐lactam antibiotics vs no antibiotics

4

2569

Risk Ratio (M‐H, Fixed, 95% CI)

1.39 [0.79, 2.43]

1.4 Antibiotics active against anaerobic bacteria vs no antibiotics

3

294

Risk Ratio (M‐H, Fixed, 95% CI)

1.63 [0.36, 7.39]

2 Stillbirth Show forest plot

8

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

2.1 Beta‐lactam antibiotics alone vs no antibiotics

4

2323

Risk Ratio (M‐H, Fixed, 95% CI)

0.91 [0.39, 2.14]

2.2 Macrolide antibiotics alone vs no antibiotics

2

2222

Risk Ratio (M‐H, Fixed, 95% CI)

0.54 [0.20, 1.48]

2.3 Macrolide and beta‐lactam antibiotics vs no antibiotics

2

2347

Risk Ratio (M‐H, Fixed, 95% CI)

0.73 [0.28, 1.90]

2.4 Antibiotics active against anaerobic bacteria vs no bacteria

3

294

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

3 Neonatal death Show forest plot

9

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

3.1 Beta‐lactam antibiotics alone vs no antibiotics

4

2323

Risk Ratio (M‐H, Fixed, 95% CI)

1.32 [0.61, 2.86]

3.2 Macrolide antibiotics alone vs no antibiotics

2

2222

Risk Ratio (M‐H, Fixed, 95% CI)

1.68 [0.77, 3.64]

3.3 Macrolide and beta‐lactam antibiotics vs no antibiotics

3

2513

Risk Ratio (M‐H, Fixed, 95% CI)

1.83 [0.88, 3.82]

3.4 Antibiotics active against anaerobic bacteria vs no antibiotics

3

294

Risk Ratio (M‐H, Fixed, 95% CI)

1.63 [0.36, 7.39]

4 Infant death Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

4.1 Beta‐lactam antibiotics alone vs no antibiotics

1

1515

Risk Ratio (M‐H, Fixed, 95% CI)

0.72 [0.31, 1.65]

4.2 Macrolide antibiotics alone vs no antibiotics

1

1586

Risk Ratio (M‐H, Fixed, 95% CI)

1.15 [0.53, 2.49]

4.3 Macrolide and beta‐lactam antibiotics vs no antibiotics

1

1553

Risk Ratio (M‐H, Fixed, 95% CI)

1.30 [0.61, 2.81]

4.4 Antibiotics active against anaerobic bacteria vs no antibiotics

0

0

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

5 Any functional impairment at 7 years of age. Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

5.1 Beta‐lactam antibiotics alone vs no antibiotics

1

1008

Risk Ratio (M‐H, Fixed, 95% CI)

1.04 [0.87, 1.25]

5.2 Macrolide antibiotics alone vs no antibiotics

1

1030

Risk Ratio (M‐H, Fixed, 95% CI)

1.13 [0.94, 1.35]

5.3 Macrolide and beta‐lactam antibiotics vs no antibiotics

1

1014

Risk Ratio (M‐H, Fixed, 95% CI)

1.13 [0.94, 1.35]

5.4 Antibiotics active against anaerobic bacteria vs no antibiotics

0

0

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

6 Moderate/severe functional impairment at 7 years of age. Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

6.1 Beta‐lactam antibiotics alone vs no antibiotics

1

1008

Risk Ratio (M‐H, Fixed, 95% CI)

1.03 [0.75, 1.41]

6.2 Macrolide antibiotics alone vs no antibiotics

1

1030

Risk Ratio (M‐H, Fixed, 95% CI)

1.08 [0.79, 1.48]

6.3 Macrolide and beta‐lactam antibiotics vs no antibiotics

1

1014

Risk Ratio (M‐H, Fixed, 95% CI)

1.12 [0.82, 1.53]

6.4 Antibiotics active against anaerobic bacteria vs no antibiotics

0

0

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

7 Cerebral palsy at 7 years of age Show forest plot

1

Risk Ratio (M‐H, Random, 95% CI)

Subtotals only

7.1 Beta‐lactam antibiotics alone vs no antibiotics

1

1049

Risk Ratio (M‐H, Random, 95% CI)

1.22 [0.41, 3.63]

7.2 Macrolide antibiotics alone vs no antibiotics

1

1073

Risk Ratio (M‐H, Random, 95% CI)

1.42 [0.48, 4.15]

7.3 Macrolide and beta‐lactam antibiotics vs no antibiotics

1

1052

Risk Ratio (M‐H, Random, 95% CI)

2.83 [1.02, 7.88]

7.4 Antibiotics active against anaerobic bacteria vs no antibiotics

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

8 Maternal adverse drug reaction requiring cessation of treatment Show forest plot

5

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

8.1 Beta‐lactam antibiotics alone vs no antibiotics

1

82

Risk Ratio (M‐H, Fixed, 95% CI)

3.15 [0.13, 75.05]

8.2 Macrolide antibiotics alone vs no antibiotics

1

103

Risk Ratio (M‐H, Fixed, 95% CI)

0.88 [0.49, 1.59]

8.3 Macrolide and beta‐lactam antibiotics vs no antibiotics

2

331

Risk Ratio (M‐H, Fixed, 95% CI)

1.49 [0.93, 2.40]

8.4 Antibiotics active against anaerobic bacteria vs no antibiotics

2

213

Risk Ratio (M‐H, Fixed, 95% CI)

1.04 [0.59, 1.83]

9 Maternal infection Show forest plot

10

Risk Ratio (M‐H, Random, 95% CI)

Subtotals only

9.1 Beta‐lactam antibiotics alone vs no antibiotics

4

2385

Risk Ratio (M‐H, Random, 95% CI)

0.74 [0.56, 0.97]

9.2 Macrolide antibiotics alone vs no antibiotics

2

2222

Risk Ratio (M‐H, Random, 95% CI)

0.82 [0.62, 1.08]

9.3 Macrolide and beta‐lactam antibiotics vs no antibiotics

4

2563

Risk Ratio (M‐H, Random, 95% CI)

0.79 [0.64, 0.98]

9.4 Antibiotics active against anaerobic bacteria vs no antibiotics

3

294

Risk Ratio (M‐H, Random, 95% CI)

0.66 [0.11, 3.92]

10 Birth within 48 hours of randomisation Show forest plot

4

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

10.1 Beta‐lactam antibiotics alone vs no antibiotics

1

2053

Risk Ratio (M‐H, Fixed, 95% CI)

1.01 [0.75, 1.36]

10.2 Macrolide antibiotics alone vs no antibiotics

1

2119

Risk Ratio (M‐H, Fixed, 95% CI)

1.06 [0.78, 1.42]

10.3 Macrolide and beta‐lactam antibiotics vs no antibiotics

3

2520

Risk Ratio (M‐H, Fixed, 95% CI)

1.12 [0.86, 1.45]

10.4 Antibiotics active against anaerobic bacteria vs no antibiotics

1

109

Risk Ratio (M‐H, Fixed, 95% CI)

0.55 [0.19, 1.57]

11 Interval between randomisation and birth (days) Show forest plot

7

Mean Difference (IV, Random, 95% CI)

Subtotals only

11.1 Beta‐lactam antibiotics alone vs no antibiotics

1

2053

Mean Difference (IV, Random, 95% CI)

‐0.09 [‐2.96, 2.78]

11.2 Macrolide antibiotics alone vs no antibiotics

3

2302

Mean Difference (IV, Random, 95% CI)

4.26 [‐2.88, 11.41]

11.3 Macrolide and beta‐lactam antibiotics vs no antibiotics

3

2221

Mean Difference (IV, Random, 95% CI)

‐0.27 [‐2.95, 2.41]

11.4 Antibiotics active against anaerobic bacteria vs no antibiotics

3

293

Mean Difference (IV, Random, 95% CI)

10.50 [4.95, 16.06]

12 Preterm birth (< 36 or < 37 weeks' gestation) Show forest plot

10

Risk Ratio (M‐H, Random, 95% CI)

Subtotals only

12.1 Beta‐lactam antibiotics alone vs no antibiotics

5

2430

Risk Ratio (M‐H, Random, 95% CI)

0.99 [0.89, 1.10]

12.2 Macrolide antibiotics alone vs no antibiotics

2

2235

Risk Ratio (M‐H, Random, 95% CI)

1.02 [0.91, 1.15]

12.3 Macrolide and beta‐lactam antibiotics vs no antibiotics

4

2613

Risk Ratio (M‐H, Random, 95% CI)

0.99 [0.89, 1.10]

12.4 Antibiotics active against anaerobic bacteria vs no antibiotics

2

226

Risk Ratio (M‐H, Random, 95% CI)

0.83 [0.53, 1.30]

13 Respiratory distress syndrome Show forest plot

5

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

13.1 Beta‐lactam antibiotics alone vs no antibiotics

3

3278

Risk Ratio (M‐H, Fixed, 95% CI)

0.93 [0.75, 1.16]

13.2 Macrolide antibiotics alone vs no antibiotics

1

3156

Risk Ratio (M‐H, Fixed, 95% CI)

0.94 [0.75, 1.18]

13.3 Macrolide and beta‐lactam antibiotics vs no antibiotics

2

3382

Risk Ratio (M‐H, Fixed, 95% CI)

1.04 [0.84, 1.29]

13.4 Antibiotics active against anaerobic bacteria vs no antibiotics

1

109

Risk Ratio (M‐H, Fixed, 95% CI)

0.59 [0.10, 3.37]

14 Necrotising enterocolitis Show forest plot

6

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

14.1 Beta‐lactam antibiotics alone vs no antibiotics

3

2227

Risk Ratio (M‐H, Fixed, 95% CI)

1.31 [0.52, 3.32]

14.2 Macrolide antibiotics alone vs no antibiotics

1

2119

Risk Ratio (M‐H, Fixed, 95% CI)

1.30 [0.44, 3.86]

14.3 Macrolide and beta‐lactam antibiotics vs no antibiotics

2

2345

Risk Ratio (M‐H, Fixed, 95% CI)

1.36 [0.60, 3.11]

14.4 Antibiotics active against anaerobic bacteria vs no antibiotics

2

190

Risk Ratio (M‐H, Fixed, 95% CI)

0.13 [0.02, 1.01]

15 Intraventricular haemorrhage Show forest plot

5

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

15.1 Beta‐lactam antibiotics alone vs no antibiotics

3

2241

Risk Ratio (M‐H, Fixed, 95% CI)

0.84 [0.38, 1.87]

15.2 Macrolide antibiotics alone vs no antibiotics

1

2119

Risk Ratio (M‐H, Fixed, 95% CI)

0.83 [0.35, 1.99]

15.3 Macrolide and beta‐lactam antibiotics vs no antibiotics

2

2345

Risk Ratio (M‐H, Fixed, 95% CI)

0.97 [0.43, 2.19]

15.4 Antibiotics active against anaerobic bacteria vs no antibiotics

1

109

Risk Ratio (M‐H, Fixed, 95% CI)

0.18 [0.02, 1.46]

Figuras y tablas -
Comparison 2. Antibiotics versus no antibiotics (subgrouped by type of antibiotic)
Comparison 3. Any macrolide versus no macrolide

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Perinatal mortality Show forest plot

4

6740

Risk Ratio (M‐H, Fixed, 95% CI)

1.20 [0.89, 1.60]

2 Stillbirth Show forest plot

2

6518

Risk Ratio (M‐H, Fixed, 95% CI)

0.70 [0.41, 1.20]

3 Neonatal death Show forest plot

3

6684

Risk Ratio (M‐H, Fixed, 95% CI)

1.52 [1.05, 2.19]

4 Infant death Show forest plot

1

4583

Risk Ratio (M‐H, Fixed, 95% CI)

1.47 [0.99, 2.18]

5 Any functional impairment at 7 years of age. Show forest plot

1

3052

Risk Ratio (M‐H, Fixed, 95% CI)

1.11 [1.01, 1.20]

6 Moderate/severe functional impairment at 7 years of age. Show forest plot

1

3052

Risk Ratio (M‐H, Fixed, 95% CI)

1.08 [0.93, 1.26]

7 Cerebral palsy at 7 years Show forest plot

1

3173

Risk Ratio (M‐H, Fixed, 95% CI)

1.90 [1.20, 3.01]

8 Maternal adverse drug reaction requiring cessation of treatment Show forest plot

2

331

Risk Ratio (M‐H, Fixed, 95% CI)

1.49 [0.93, 2.40]

9 Maternal infection Show forest plot

4

6745

Risk Ratio (M‐H, Random, 95% CI)

0.66 [0.41, 1.07]

10 Birth within 48 hours of randomisation Show forest plot

3

6691

Risk Ratio (M‐H, Fixed, 95% CI)

1.08 [0.94, 1.25]

11 Interval between randomisation and birth (days) Show forest plot

3

6386

Mean Difference (IV, Random, 95% CI)

1.07 [‐3.58, 5.72]

12 Preterm birth (< 36 or < 37 weeks) Show forest plot

4

6784

Risk Ratio (M‐H, Fixed, 95% CI)

1.01 [0.95, 1.07]

13 Respiratory distress syndrome Show forest plot

4

6740

Risk Ratio (M‐H, Fixed, 95% CI)

1.04 [0.90, 1.21]

14 Intraventricular haemorrhage Show forest plot

2

6516

Risk Ratio (M‐H, Fixed, 95% CI)

0.96 [0.62, 1.49]

15 Necrotising enterocolitis Show forest plot

2

6516

Risk Ratio (M‐H, Fixed, 95% CI)

1.16 [0.74, 1.80]

Figuras y tablas -
Comparison 3. Any macrolide versus no macrolide
Comparison 4. Any beta‐lactam versus no beta‐lactam

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Perinatal mortality Show forest plot

8

7109

Risk Ratio (M‐H, Fixed, 95% CI)

1.12 [0.84, 1.48]

2 Stillbirth Show forest plot

6

6887

Risk Ratio (M‐H, Fixed, 95% CI)

1.10 [0.76, 1.58]

3 Neonatal death Show forest plot

7

7053

Risk Ratio (M‐H, Fixed, 95% CI)

1.51 [1.06, 2.15]

4 Infant death Show forest plot

1

4654

Risk Ratio (M‐H, Fixed, 95% CI)

0.94 [0.64, 1.38]

5 Any functional impairment at 7 years of age. Show forest plot

1

3052

Risk Ratio (M‐H, Fixed, 95% CI)

1.02 [0.93, 1.11]

6 Moderate/severe functional impairment at 7 years of age. Show forest plot

1

3052

Risk Ratio (M‐H, Fixed, 95% CI)

1.03 [0.88, 1.20]

7 Cerebral palsy at 7 years Show forest plot

1

3173

Risk Ratio (M‐H, Fixed, 95% CI)

1.67 [1.06, 2.61]

8 Maternal adverse drug reaction requiring cessation of treatment Show forest plot

4

523

Risk Ratio (M‐H, Fixed, 95% CI)

1.61 [1.02, 2.54]

9 Maternal infection Show forest plot

8

7182

Risk Ratio (M‐H, Fixed, 95% CI)

0.80 [0.69, 0.92]

10 Birth within 48 hours of randomisation Show forest plot

4

6800

Risk Ratio (M‐H, Fixed, 95% CI)

1.02 [0.89, 1.18]

11 Interval between randomisation and birth (days) Show forest plot

3

6386

Mean Difference (IV, Random, 95% CI)

3.92 [‐5.08, 12.92]

12 Preterm birth (< 36 or < 37 weeks) Show forest plot

8

7185

Risk Ratio (M‐H, Fixed, 95% CI)

0.98 [0.92, 1.04]

13 Respiratory distress syndrome Show forest plot

8

7108

Risk Ratio (M‐H, Fixed, 95% CI)

1.02 [0.88, 1.19]

14 Intraventricular haemorrhage Show forest plot

4

6721

Risk Ratio (M‐H, Fixed, 95% CI)

0.86 [0.56, 1.31]

15 Necrotising enterocolitis Show forest plot

5

6788

Risk Ratio (M‐H, Random, 95% CI)

0.72 [0.27, 1.92]

Figuras y tablas -
Comparison 4. Any beta‐lactam versus no beta‐lactam