Role of Antibiotics in Preventing Infection in Babies Born Through Meconium Stained Liquor
Information source: Lady Hardinge Medical College
ClinicalTrials.gov processed this data on August 23, 2015 Link to the current ClinicalTrials.gov record.
Condition(s) targeted: Neonatal Sepsis
Intervention: Piperacillin-Tazobactam and Amikacin (Drug)
Phase: N/A
Status: Recruiting
Sponsored by: Lady Hardinge Medical College Official(s) and/or principal investigator(s): Sushma Nangia, MBBS, MD, DM, Study Chair, Affiliation: Lady Hardinge Medical College, New Delhi, India
Summary
The purpose of the study is to evaluate the role of antibiotics in preventing infection in
babies born through meconium stained amniotic fluid. Normally babies do not pass meconium
while in utero. In response to hypoxic stress babies may pass meconium before birth and are
likely to be candidates for problems related to meconium passage and its inhalation. It is
believed that these babies are more prone to infections as meconium enhances bacterial
growth and may predispose such babies to secondary bacterial infections. In addition,
meconium passage has been incriminated as a pointer of in-utero infection. Whether use of
antibiotics in babies born through meconium stained amniotic fluid will reduce the
infectious episodes and complications thereof or not is not clear. Moreover, there is not
much published literature to prove or refute the same. Most clinicians have a low threshold
for using antibiotics in such babies. In view of the uncertainty regarding antibiotic usage
in these babies, the investigators decided to investigate the role of prophylactic
antibiotics in prevention of neonatal sepsis in babies born through meconium stained
amniotic fluid.
Clinical Details
Official title: Role of Prophylactic Antibiotics in Preventing Neonatal Sepsis in Neonates Born Through Meconium Stained Amniotic Fluid - A Randomized Controlled Trial
Study design: Allocation: Randomized, Endpoint Classification: Efficacy Study, Intervention Model: Parallel Assignment, Masking: Open Label, Primary Purpose: Prevention
Primary outcome: Incidence of sepsis
Secondary outcome: Mortality;Respiratory support; Duration of Hospital stay Complications
Detailed description:
Meconium passage in newborn infants is a developmentally programmed event normally occurring
within first 24-48 hours of birth. Intra uterine meconium passage in near term or term
fetuses has been associated with feto-maternal stress factors and/or infections, whereas
meconium passage in post term pregnancies has been attributed to gastro-intestinal maturity.
The meconium staining of amniotic fluid occurs in 12% of all live births per annuum.
Aspiration of meconium that occurs during intra uterine life or after delivery with the
first few breaths may result in or contribute to respiratory pathology known as meconium
aspiration syndrome (MAS) which represents a leading cause of the perinatal morbidity,
occurring in 5-20% of all babies born through MSAF.
The routine use of antibiotics in MSAF babies has been advocated for a long time as a part
of the conventional treatment. Meconium passage in utero is hypothesized to represent a
response to fetal bacterial infection in addition to intrauterine hypoxia. Additionally the
rationale for use of antibiotics includes the radiographic similarity of MAS to bacterial
pneumonia, in vitro enhancement of bacterial growth in presence of meconium as well as the
possibility of meconium induced inhibition of phagocytic activity and respiratory burst
response by alveolar macrophages rendering patients with MAS more susceptible to infection.
These recommendations however are empirical and the incidence of bacterial infection in
neonates born through MSAF as well as in MAS has not been systematically evaluated, to date.
With the rising concern about the emergence of resistant strains in neonatal ICUs and the
possible side effects of antibiotics (like amino glycosides) including nephrotoxicity and
ototoxicity in neonates, a systematically conducted, randomized controlled trial is
necessary to assess the utility of antibiotics in the routine management of infants with
MSAF and MAS. Hence the purpose of this prospective randomized controlled trial is to
compare the clinical course, complications, and infection related outcomes in cases of MSAF
and MAS, treated with or without antibiotics therapy
Eligibility
Minimum age: N/A.
Maximum age: 2 Hours.
Gender(s): Both.
Criteria:
Inclusion Criteria:
- Gestation > 37 weeks
- Meconium staining of amniotic fluid
- Cephalic presentation
- Singleton pregnancy
Exclusion Criteria:
- Major Congenital malformation
- Refusal of consent
Locations and Contacts
Kalawati Saran children's Hospital, Lady Hardinge Medical College, New Delhi, Delhi 110001, India; Recruiting Sushma Nangia, MBBS,MD,DM, Phone: 09810838181, Email: drsnangia@gmail.com Arvind Saili, MBBS, MD, Phone: 09868117699, Email: sailiarvind@gmail.com Ankita Goel, MBBS, Sub-Investigator Sushma Nangia, MBBS,MD,DM, Principal Investigator
Additional Information
Starting date: June 2010
Last updated: December 23, 2012
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