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Antibióticos para el líquido amniótico teñido con meconio en el trabajo de parto para la prevención de las infecciones maternas y neonatales

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Referencias

Referencias de los estudios incluidos en esta revisión

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Adair 1996 {published data only}

Adair CD, Ernest JM, Sanchez‐Ramos L, Burrus DR, Boles ML, Veille J. Meconium‐stained amniotic fluid‐associated infectious morbidity: a randomized, double‐blind trial of ampicillin‐sulbactam prophylaxis. Obstetrics & Gynecology 1996;88(2):216‐20.

Referencias de los estudios excluidos de esta revisión

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Adair 1998 {published data only}

Adair CD, Ernest JM, Sanchez‐Ramos L, Burrus DR, Boles ML, Veille JC. The utility of amnioinfusion in the prophylaxis of meconium‐stained amniotic fluid infectious morbidity. Infectious Diseases in Obstetrics and Gynecology 1998;5:366‐9.

Adair 1999 {published data only}

Adair CD, Lewis D, Weeks J, Vandenberg T, Barrilleaux S, Philibert L, et al. Is meconium‐stained amniotic fluid infectious morbidity reduced by prophylactic ampicillin sulbactam?. American Journal of Obstetrics and Gynecology 1999;180:s22.

Edwards 1999 {published data only}

Edwards RK, Duff P. Prophylactic cefazolin in amnioinfusions administered for meconium‐stained amniotic fluid. Infectious Diseases in Obstetrics and Gynecology 1999;7(3):153‐7.

Referencias adicionales

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Alexander 1999

Alexander JM, McIntire DM, Leveno KJ. Chorioamnionitis and the prognosis for term infants. Obstetrics & Gynecology 1999;94:274‐8.

Berkus 1994

Berkus MD, Langer O, Samueloff A. Meconium‐stained amniotic fluid: increased risk for adverse neonatal outcome. Obstetrics & Gynecology 1994;84:115‐20.

Casey 1997

Casey BM, Cox SM. Chorioamnionitis and endomyometritis. Infectious Disease Clinics of North America 1997;11:203‐22.

Clark 1995

Clark P, Duff P. Inhibition of neutrophil oxidative burst and phagocytosis by meconium. American Journal of Obstetrics and Gynecology 1995;173:1301‐5.

Cleary 1998

Cleary GM, Wiswell TE. Meconium‐stained amniotic fluid and the meconium aspiration syndrome. An update. Pediatric Clinics of North America 1998;45:511‐29.

Egger 1997

Egger M, Smith GD, Schneider M, Minder C. Bias in meta‐analysis detected by a simple, graphical test. BMJ 1997;315:629‐34.

Florman 1969

Florman AL, Teubner D. Enhancement of bacterial growth in amniotic fluid by meconium. Journal of Pediatrics 1969;74:111‐4.

Halliday 2001

Halliday HL, Sweet D. Endotracheal intubation at birth for preventing morbidity and mortality in vigorous, meconium‐stained infants born at term. Cochrane Database of Systematic Reviews 2001, Issue 1. [DOI: 10.1002/14651858.CD000500]

Harbord 2006

Harbord RM, Egger M, Sterne JA. A modified test for small‐study effects in meta‐analyses of controlled trials with binary endpoints. Statistics in Medicine 2006;25:3443‐57.

Heizmann 2007

Heizmann P, Heizmann WR. Bacteriostatic ‐ bactericidal [Bakteriostase ‐ Bakterizidie]. Medizinische Klinik 2007;102(9):720‐6.

Higgins 2009

Higgins JPT, Green S, editors. Cochrane Handbook for Systematic Reviews of Interventions Version 5.0.2 [updated September 2009]. The Cochrane Collaboration, 2009. Available from www.cochrane‐handbook.org.

Hofmeyr 2002

Hofmeyr GJ. Amnioinfusion for meconium‐stained liquor in labour. Cochrane Database of Systematic Reviews 2002, Issue 1. [DOI: 10.1002/14651858.CD000014]

Hoskins 1987

Hoskins AI, Hemming VG, Johnson TRB, Winkel CA. Effects of alterations of zinc‐to‐phosphorus ratios and meconium content on group B Streptococcus growth in human amniotic fluid in vitro. American Journal of Obstetrics and Gynecology 1987;157(3):770‐3.

Josephson 1984

Josephson A. An epidemiologic study of postcesarean infection. American Journal of Infection Control 1984;12:19‐25.

Katz 1992

Katz VL, Bowes WA. Meconium aspiration syndrome: reflection on a musky subject. American Journal of Obstetrics and Gynecology 1992;166:171‐83.

Mark 2000

Mark SP, Croughan‐Minihane MS, Kilpatrick SJ. Chorioamnionitis and uterine dysfunction. Obstetrics & Gynecology 2000;95:909‐12.

Markovitch 1993

Markovitch O, Mazor M, Shoham‐Vardi I, Chaim W. Meconium stained amniotic fluid is associated with maternal infectious morbidity in preterm delivery. Acta Obstetricia et Gynecologica Scandinavica 1993;72:538‐42.

Mazor 1995

Mazor M, Furman B, Wiznitzer A, Shoham‐Vardi I, Cohen J, Ghezzi F. Maternal and perinatal outcome of patients with preterm labor and meconium‐stained amniotic fluid. Obstetrics & Gynecology 1995;86:830‐3.

Nathan 1994

Nathan L, Leveno KJ, Carmody TJ, Kelly MA, Sherman ML. Meconium: a 1990s perspective on an old obstetric hazard. Obstetrics & Gynecology 1994;83:329‐32.

Piper 1998

Piper JM, Newton ER, Berkus MD, Peairs WA. Meconium: a marker for peripartum infection. Obstetrics & Gynecology 1998;91:741‐5.

RevMan 2008 [Computer program]

The Nordic Cochrane Centre, The Cochrane Collaboration. Review Manager (RevMan). Version 5.0. Copenhagen: The Nordic Cochrane Centre, The Cochrane Collaboration, 2008.

Romero 1991

Romero R, Hanaoka S, Mazor M, Athanassiadis AP, Callaghan R, Hsu YC, et al. Meconium‐stained amniotic fluid: a risk factor for microbial invasion of the amniotic cavity. American Journal of Obstetrics and Gynecology 1991;164(3):859‐62.

Shivananda 2006

Shivananda S, Murthy P, Shah PS. Antibiotics for neonates born through meconium stained amniotic fluid. Cochrane Database of Systematic Reviews 2006, Issue 4. [DOI: 10.1002/14651858.CD006183]

Tran 2003

Tran SH, Caughey AB, Musci TJ. Meconium‐stained amniotic fluid is associated with puerperal infections. American Journal of Obstetrics and Gynecology 2003;189(3):746‐50.

Usta 2000

Usta IM, Sibai BM, Mercer BM. Use of maternal plasma level of zinc‐coproporphyrin in the prediction of intrauterine passage of meconium: a pilot study. Journal of Maternal‐Fetal Medicine 2000;9:201‐3.

Ward 2003

Ward M, Sinn J. Steroid therapy for meconium aspiration syndrome in newborn infant. Cochrane Database of Systematic Reviews 2003, Issue 4. [DOI: 10.1002/14651858.CD003485]

Ward 2008

Ward K, Theiler RN. Once‐daily dosing of gentamicin in obstetrics and gynecology. Clinical Obstetrics and Gynecology 2008;51(3):498‐506.

Wiswell 1990

Wiswell TE, Tuggle JM, Tumer BS. Meconium aspiration syndrome: have we made a difference?. Pediatrics 1990;85:715‐21.

Characteristics of studies

Characteristics of included studies [ordered by study ID]

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Adair 1996

Methods

Randomized trial with allocation concealment using computer‐generated randomization list. All participants, caregivers and outcome assessors were blinded to the treatment regimen.

Participants

Intervention group: 60 pregnant women (mean age 24.5, SD 6.3) with gestational age more than 24 weeks (mean 39.8, SD 1.0).

Control group: 60 pregnant women (mean age 25.9, SD 6.3), (mean gestational age 39.9, SD 1.2).

Inclusion criteria: gestational age more than 24 weeks with MSAF complicating the intrapartum.

Exclusion criteria: patients with penicillin and/or cephalosporin allergy, evidence of active infection, presence of intrauterine death, GA < 24 weeks, or history of antibiotics use in 7 days.

Location: North Carolina, United States.

Interventions

Intervention: ampicillin‐sulbactam 3.0 g intravenous prepared in 100 ml fluid bags, and was repeated every 6 hours until delivery.

Control: normal saline infused as an IV bolus.

Outcomes

Mother
Chorioamnionitis.
Postpartum endometritis.

Neonatal
Number of NICU admissions.
Incidence of sepsis (not defined), and adverse outcomes including enterocolitis and respiratory distress.

Notes

Risk of bias

Bias

Authors' judgement

Support for judgement

Adequate sequence generation?

Low risk

Randomization was performed by a computer‐generated list.

Allocation concealment?

Low risk

Adequate: there was randomization by computer‐generated list and both IV preparations were prepared by 1 of 2 research nurses who were not involved in this study.

Blinding?
All outcomes

Low risk

Adequate: there was blinding of participants, caregivers and outcome assessor.

Incomplete outcome data addressed?
All outcomes

Low risk

Adequate: there was no withdrawal.

Free of selective reporting?

Unclear risk

Unclear, because we don't have access to this trial's outcomes.

Free of other bias?

Low risk

Study appeared to be free of other sources.

GA: gestational age
IV: intravenous
MSAF: meconium‐stained amniotic fluid
NICU: neonatal intensive care unit
RCT: randomized controlled trial
SD: standard deviation

Characteristics of excluded studies [ordered by study ID]

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Study

Reason for exclusion

Adair 1998

Not a RCT, this was a retrospective cohort study.

Adair 1999

This is a conference abstract.

Edwards 1999

Intervention not of interest to systematic review, it is not systematic prophylactic antibiotics.

RCT: randomized controlled trial

Data and analyses

Open in table viewer
Comparison 1. Antibiotic versus placebo

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Neonatal sepsis Show forest plot

1

120

Risk Ratio (M‐H, Fixed, 95% CI)

1.0 [0.21, 4.76]
Analysis 1.1
Comparison 1 Antibiotic versus placebo, Outcome 1 Neonatal sepsis.

Comparison 1 Antibiotic versus placebo, Outcome 1 Neonatal sepsis.

2 Chorioamnionitis Show forest plot

1

120

Risk Ratio (M‐H, Fixed, 95% CI)

0.29 [0.10, 0.82]
Analysis 1.2
Comparison 1 Antibiotic versus placebo, Outcome 2 Chorioamnionitis.

Comparison 1 Antibiotic versus placebo, Outcome 2 Chorioamnionitis.

3 Postpartum endometritis Show forest plot

1

120

Risk Ratio (M‐H, Fixed, 95% CI)

0.5 [0.18, 1.38]
Analysis 1.3
Comparison 1 Antibiotic versus placebo, Outcome 3 Postpartum endometritis.

Comparison 1 Antibiotic versus placebo, Outcome 3 Postpartum endometritis.

4 Neonatal intensive care admissions Show forest plot

1

120

Risk Ratio (M‐H, Fixed, 95% CI)

0.83 [0.39, 1.78]
Analysis 1.4
Comparison 1 Antibiotic versus placebo, Outcome 4 Neonatal intensive care admissions.

Comparison 1 Antibiotic versus placebo, Outcome 4 Neonatal intensive care admissions.

Methodological quality summary: review authors' judgements about each methodological quality item for each included study.
Figuras y tablas -
Figure 1

Methodological quality summary: review authors' judgements about each methodological quality item for each included study.

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Methodological quality graph: review authors' judgements about each methodological quality item presented as percentages across all included studies.
Figuras y tablas -
Figure 2

Methodological quality graph: review authors' judgements about each methodological quality item presented as percentages across all included studies.

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Comparison 1 Antibiotic versus placebo, Outcome 1 Neonatal sepsis.
Figuras y tablas -
Analysis 1.1

Comparison 1 Antibiotic versus placebo, Outcome 1 Neonatal sepsis.

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Comparison 1 Antibiotic versus placebo, Outcome 2 Chorioamnionitis.
Figuras y tablas -
Analysis 1.2

Comparison 1 Antibiotic versus placebo, Outcome 2 Chorioamnionitis.

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Comparison 1 Antibiotic versus placebo, Outcome 3 Postpartum endometritis.
Figuras y tablas -
Analysis 1.3

Comparison 1 Antibiotic versus placebo, Outcome 3 Postpartum endometritis.

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Comparison 1 Antibiotic versus placebo, Outcome 4 Neonatal intensive care admissions.
Figuras y tablas -
Analysis 1.4

Comparison 1 Antibiotic versus placebo, Outcome 4 Neonatal intensive care admissions.

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Comparison 1. Antibiotic versus placebo

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Neonatal sepsis Show forest plot

1

120

Risk Ratio (M‐H, Fixed, 95% CI)

1.0 [0.21, 4.76]

2 Chorioamnionitis Show forest plot

1

120

Risk Ratio (M‐H, Fixed, 95% CI)

0.29 [0.10, 0.82]

3 Postpartum endometritis Show forest plot

1

120

Risk Ratio (M‐H, Fixed, 95% CI)

0.5 [0.18, 1.38]

4 Neonatal intensive care admissions Show forest plot

1

120

Risk Ratio (M‐H, Fixed, 95% CI)

0.83 [0.39, 1.78]
Figuras y tablas -
Comparison 1. Antibiotic versus placebo
Ir a la tabla de la revisión