Antibiotics for Cesarean Effective After Cord Clamping, Better for Baby

By Megan Brooks

December 24, 2020

NEW YORK (Reuters Health) - For pregnant women delivering by cesarean section, delaying antibiotic administration until after cord clamping is no less effective and could benefit newborns' developing microbiome, a large study suggests.

Guidelines from the World Health Organization advise administering antimicrobial prophylaxis in cesarean births before incision to prevent surgical site infections.

"Infants born by cesarean are exposed to the antibiotics administered to the mother, typically from before the surgery start. Exposure to antibiotics in early life is known to increase the risk of immune and metabolic diseases in early life," co-author Dr. Maria Gloria Dominguez-Bello of Rutgers University, in New Brunswick, New Jersey, told Reuters Health by email.

"This is the first study, and a big one, showing that using the antibiotics post-umbilical cord clamping protects the mother from infections and this practice would reduce the infant exposure to the antibiotics," she said.

The study, led by Dr. Rami Sommerstein of Bern University Hospital in Switzerland, included more than 55,000 women undergoing cesarean section at 75 hospitals in Switzerland from 2009 to 2018, with 26,405 women receiving antibiotics before skin incision and 29,496 after umbilical cord clamping.

There were 846 documented surgical site infections - 1.6% in women who received pre-incision antibiotics and 1.7% in women who received antibiotics after cord clamping (P= 0.759).

Surgical antimicrobial prophylaxis administration after clamping was not significantly associated with an increased SSI rate (odds ratio, 1.14; 95% confidence interval 0.96 to 1.36; P=0.144) when compared to before incision.

"Supplementary and subgroup analyses supported these main results," the study team reports in the journal Antimicrobial Resistance and Infection Control.

"The difference, if there was any difference, was really, really low," Dr. Sommerstein noted in a phone interview with Reuters Health.

"And we should bear in mind that these are not fatal infections. We're speaking of wound infections that do require antibiotics sometimes - rarely, they required a second surgery - but these are not life-threatening infections and we think that the advantage for the baby is big enough," Dr. Sommerstein said.

"We feel that our study is important and some hospitals in Switzerland already apply surgical antimicrobial prophylaxis after clamping in order to spare the newborn from antibiotics because they didn't see a lot of infections," Dr. Sommerstein added.

The researchers think guidance on the best timing for antimicrobial prophylaxis for cesarean births should be reevaluated.

"Because of collateral effects of antibiotics, in particular, effects on the microbiome, we need to revise and optimize their use. Oftentimes the use of antibiotics ignores or disregards these collateral effects," Dr. Dominguez-Bello noted in email to Reuters Health.

"The impact on the pregnant woman is minimal" when antimicrobial prophylaxis is given after clamping, coauthor Dr. Andreas Widmer of the National Center for Infection Control, in Bern, added in an email to Reuters Health.

"Repetitive doses of antibiotics in childhood is clearly related to Crohn's disease, likely triggered by changing the microbiome in the gut," Dr. Widmer said. Giving antibiotics at incision exposes the newborn to antibiotics that "may change their life as the immune system is developing," he added.

SOURCE: Antimicrobial Resistance and Infection Control, online December 21, 2020.