Long term impact of prophylactic antibiotic use before incision VS after cord clamping on Children by caesarean section
The British Medical Journal (BMJ): Published 17 May 2022
Compared with vaginal delivery, caesarean section carries a substantially increased risk of maternal postpartum infections. This risk can be reduced by routine provision of prophylactic antibiotics.
Evidence from randomized controlled trials shows that antibiotics are more effective at reducing the risk of maternal infectious morbidity after delivery if given before incision rather than after cord clamping.
Since 2011, the National Institute for Health and Care Excellence (NICE) has recommended prophylactic antibiotics before incision in mothers undergoing caesarean section.
TAKE HOME MESSAGE:
Antibiotics given pre-incision cross the placenta and therefore babies are exposed to them around the time of birth; and at a time when the human gut becomes colonised by microbes.
A growing body of evidence suggests that microbiota of the infant gut play a key role in the development of the immune system, which includes regulation of response to different antigens and inflammation.
Intrapartum antibiotics alter the intestinal microbiota of infants, although the effect on gut microbiota is less evident in children born by caesarean section. Disruptions to the gut microbiota are associated with susceptibility to asthma, eczema, allergies, and other immune related diseases in childhood.
Authors investigated the effect of a change in prophylactic antibiotic policy from after cord clamping to before incision on the incidence of allergic and other related health conditions in children born by caesarean section.
In this large population based study, Authors did not find evidence for an association between a prophylactic antibiotics before incision for caesarean section and risk of asthma, eczema, and other allergic and allergy related conditions.
Authors also did not find convincing evidence for an increased risk of other conditions, including autoimmune diseases, immune system related conditions, infections, and neurodevelopmental conditions.
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Objective To investigate the impact on child health up to age 5 years of a policy to use antibiotic prophylaxis for caesarean section before incision compared with after cord clamping.
Design Observational controlled interrupted time series study.
Setting UK primary and secondary care.
Participants 515 945 children born in 2006-18 with linked maternal records and registered with general practices contributing to two UK primary care databases (The Health Improvement Network and Clinical Practice Research Datalink), and 7 147 884 children with linked maternal records in the Hospital Episode Statistics database covering England, of which 3 945 351 were linked to hospitals that reported the year of policy change to administer prophylactic antibiotics for caesarean section before incision rather than after cord clamping.
Intervention Fetal exposure to antibiotics shortly before birth (using pre-incision antibiotic policy as proxy) compared with no exposure.
Main outcome measures The primary outcomes were incidence rate ratios of asthma and eczema in children born by caesarean section when pre-incision prophylactic antibiotics were recommended compared with those born when antibiotics were administered post-cord clamping, adjusted for temporal changes in the incidence rates in children born vaginally.
Results Prophylactic antibiotics administered before incision for caesarean section compared with after cord clamping were not associated with a significantly higher risk of asthma or eczema, including asthma and eczema resulting in hospital admission, up to age 5 years.
Conclusions This study found no evidence of an association between pre-incision prophylactic antibiotic use and risk of asthma and eczema in early childhood in children born by caesarean section.
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