555 - Maternal Penicillin Allergy is Associated with Neonatal Late Onset Sepsis in Neonates Born After PPROM

Poster Number: 555
Publication Number: 555.428

Alexandria Sasaki, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States; Danielle Browning, UPMC Childrens Hospital of Pittsburgh, Pittsburgh, PA, United States; Christina Megli, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States

Background: PPROM is associated with an increased risk of ascending infection resulting in adverse maternal and neonatal outcomes. Current antepartum management of PPROM includes 7 days of antibiotics to prolong pregnancy and potentially improve neonatal outcomes. There is limited data comparing standard β-lactam antibiotic regimens and alternate non-β-lactam regimens in the setting of maternal allergy.

Objective: Our objective was to determine if rates of neonatal outcomes including early-onset sepsis (EOS), late-onset sepsis (LOS), necrotizing enterocolitis (NEC), bronchopulmonary dysplasia (BPD), and gestational age at delivery differed between neonates from mothers who received β-lactam latency antibiotics when compared to those whose mothers received alternate latency antibiotic regimens.

Design/Methods: This is a retrospective cohort study of patients admitted to Magee Women’s Hospital with a diagnosis of PPROM. Women were identified by ICD-9 (658.10) and ICD-10 (O42.913) codes from 2015-2017. Women who delivered >34 weeks or < 23 weeks and women who were not expectantly managed were excluded. A detailed chart analysis abstracted maternal and neonatal outcomes. Data were stratified by latency antibiotic regimen with β-lactam antibiotics or using non-β-lactam antibiotics.

Results: 212 pregnant women were identified that met inclusion criteria; of those, 17 (7.6%) received non-β-lactam antibiotic regimens and 195 (92.4%) received standard antibiotic regimens. Antenatal and postnatal characteristics were similar between both groups including maternal age, gestational age at delivery, initial WBC, birthweight, and gestational age of PPROM (Table 1). Neonates whose mothers received non-beta lactam antibiotics had more evaluations for sepsis (1.63 evaluations vs 1.29) and this approached statistical significance p=0.06. There was no difference between EOS, BPD, NEC, or neonatal death for neonates whose mothers received non-β-lactam antibiotics. Interestingly, neonates whose mothers received non-β-lactam antibiotics were more likely to develop LOS (17.7% versus 2.0%, p=0.0006) (Table 2).Conclusion(s): We found that neonates whose mothers received non-β-lactam antibiotic regimens for PPROM had higher rates of LOS suggesting that antenatal antibiotic exposure to gentamicin, clindamycin, and vancomycin may predispose preterm infants to LOS. Future studies in larger cohorts are needed to confirm this association. Our data suggest that further studies look at the mechanism of antenatal antibiotic exposure, neonatal microbiome and immune development, and late-onset sepsis.
Table 1. Antenatal and postnatal characteristics of women receiving β-lactam antibiotic regimens and non-β-lactam antibiotic regimens following PPROMSlide1.jpeg
Table 2. Neonatal outcomes of women receiving β-lactam antibiotic regimens and non-β-lactam antibiotic regimens following PPROMSlide2.jpeg