Review article

https://doi.org/10.57140/mj.54.2.5

The Role of Antibiotic Therapy on the Children's Neurological Outcome in Preterm Premature Rupture of Membranes

Stjepan Bulat ; University of Zagreb, School of Medicine, Zagreb, Croatia
Živka Dika ; University of Zagreb, School of Medicine, Zagreb, Hrvatska, Zagreb University Hospital Centre, Department of Internal Medicine, Zagreb, Croatia
Boris Lovrić ; University Josip Juraj Strossmayer Osijek, Faculty of Dental Medicine and Health, Osijek, Croatia; Nova Gradiška General Hospital, Department of Obstetrics and Gynecology, Nova Gradiška, Croatia
Luka Matak ; Zadar General Hospital, Department of Obstetrics and Gynecology, Zadar, Croatia
Vesna Elveđi Gašparović ; University of Zagreb, School of Medicine, Zagreb, Croatia; Zagreb University Hospital Centre, Department of Obstetrics and Gynecology, Zagreb, Croatia
Josip Juras orcid.org/0000-0002-1801-5732 ; University of Zagreb, School of Medicine, Zagreb, Croatia; Zagreb University Hospital Centre, Department of Obstetrics and Gynecology, Zagreb, Croatia

Abstract

Preterm premature rupture of membranes (PPROM) occurs in 3% of all pregnancies and is responsible
for approximately one-third of all preterm births, causing significant perinatal morbidity and fetal death. In
a significant number of PPROM cases an infection is present although it is sometimes difficult to determine
clinically. Our knowledge of pathophysiology of intrauterine infection/inflammation and impact of
antibiotic therapy on its clinical course is elementary. It is known that intrauterine infection/inflammation
is a significant risk factor for developing neurological impairment in children. Prophylactic administration
of antibiotics might eradicate infection in women with PPROM and improve neonatal outcomes, on the
other hand, it could only increase the period of latency and suppress infection to a subclinical level without
eradicating the underlying infection, leaving the fetus in an unfavorable intrauterine environment. Still, the
European and the American guidelines recommend routine administration of antibiotic therapy in women
presenting with PPROM. Studies have shown that administration of antibiotics increases the period of
latency and improves certain short-term neurological outcomes such as reducing the rate of abnormal
cerebral ultrasound scan prior to the discharge from hospital, but it does not reduce perinatal mortality, the
rate of preterm births and does not have an effect on long-term neurological outcomes. Furthermore,
guidelines for antibiotics administration on PPROM are largely based on deficient, low quality and possibly
outdated evidence. Optimal regimen and duration of antibiotic therapy are not clear and new studies
estimating changes in bacterial resistance and more common clinical use of cephalosporines in the clinical
management of PPROM are necessary.

Keywords

preterm premature rupture of membranes (PPROM); antibiotics; chorioamnionitis; neurological outcomes

Hrčak ID:

318011

URI

https://hrcak.srce.hr/318011

Publication date:

18.6.2024.

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