morphine and Bacterial-Infections

Approximately 1 in 10 pregnancies is affected by meconium passage at delivery, which can result in meconium aspiration syndrome (MAS). MAS can cause respiratory complications and, very rarely, death. Antibiotics have been prescribed for neonates exposed to meconium in amniotic fluid, with the intention of preventing infection due to potential bacterial contaminants.. We conducted this review to assess the efficacy and safety of antibiotics for:1. prevention of infection, morbidity, and mortality among infants born through meconium-stained amniotic fluid (MSAF) who are asymptomatic at birth; and2. prevention of infection, morbidity, and mortality among infants born through MSAF who have signs and symptoms compatible with meconium aspiration syndrome (MAS).. We performed a literature search using the following databases: MEDLINE (1966 to July 2016); Embase (1980 to July 2016); the Cumulative Index to Nursing and Allied Health Literature (CINAHL; 1982 to July 2016); and the Cochrane Central Register of Controlled Trials (CENTRAL; 2016, Issue 7) in the Cochrane Library. We also searched clinical trials databases, conference proceedings, and reference lists of retrieved articles.. We included randomised and quasi-randomised controlled trials that compared antibiotics administered via any route versus placebo or no treatment for prevention of infection among neonates exposed to MSAF, or who developed MAS. We excluded cohort, case control, and any other non-randomised studies and applied no language restrictions. We included studies of term and preterm infants, and we included studies examining use of any antibacterial antibiotics. We included studies that reported on any outcomes of interest.. We assessed the methodological quality of included trials by reviewing information provided in study reports and obtained by personal communication with study authors. We extracted data on relevant outcomes, estimated effect size, and reported values as risk ratios (RRs), risk differences (RDs), and mean differences (MDs), as appropriate. We conducted subgroup analyses for treatment of MAS and for prophylaxis (asymptomatic neonates exposed to meconium).. Four randomised controlled studies including a total of 695 participants were eligible for inclusion. Three studies evaluated neonates with MAS, and one study assessed asymptomatic neonates exposed to meconium in amniotic fluid. These studies exhibited varying degrees of methodological rigour: Two studies were at low risk of bias, and two were at unclear risk. We graded evidence derived from these studies as low quality. We downgraded overall evidence owing to the large number of participants lost to follow-up in one trial, the small sample sizes of all trials, and unclear methodological details provided for two trials.The primary outcome was risk of early- and late-onset neonatal sepsis. Antibiotics did not decrease the risk of sepsis in neonates with a diagnosis of MAS (RR 1.54, 95% confidence interval (CI) 0.27 to 8.96; RD 0.00, 95% CI -0.02 to 0.03; 445 participants, three studies; I² = 0%) nor in asymptomatic neonates exposed to meconium in amniotic fluid (RR 0.76, 95% CI 0.25 to 2.34; RD -0.01, 95% CI -0.07 to 0.04; 250 participants, one study; I² = 0%). Results show no significant differences in mortality or duration of stay in hospital between groups given antibiotics and control groups of symptomatic and asymptomatic neonates. One study in asymptomatic neonates reported a significant reduction in duration of mechanical ventilation for the control group compared with the antibiotic group (MD 0.26, 95% CI 0.15 to 0.37; 250 participants, one study; I² = 0%).. Upon review of available evidence, we found no differences in infection rates following antibiotic treatment among neonates born through meconium-stained fluid and those with meconium aspiration syndrome. The overall quality of evidence is low owing to the small number of included studies. Well-controlled studies of adequate power are needed.

Topics: Amikacin; Amniotic Fluid; Ampicillin; Anti-Bacterial Agents; Bacterial Infections; Gentamicins; Humans; Incidence; Infant, Newborn; Length of Stay; Meconium; Meconium Aspiration Syndrome; Neonatal Sepsis; Randomized Controlled Trials as Topic; Respiration, Artificial; Respiratory Insufficiency

Topics: Acidosis; Animals; Animals, Newborn; Asphyxia Neonatorum; Bacterial Infections; Cerebral Hemorrhage; Erythroblastosis, Fetal; Female; Fetal Diseases; Hepatitis, Animal; Horse Diseases; Horses; Humans; Hypoglycemia; Hypoxia; Infant, Newborn; Meconium; Nephritis; Pregnancy; Respiratory Insufficiency; Seizures; Syndrome; Virus Diseases

To evaluate the efficacy of intrapartum prophylactic administration of ampicillin-sulbactam in reducing intraamniotic infection and postpartum endometritis in patients with meconium-stained amniotic fluid (AF).. Patients with intrapartum meconium-stained AF were randomized to receive either ampicillin-sulbactam or normal saline (placebo) intravenously at the time of diagnosis of meconium and every 6 hours until delivery. The outcomes of the two groups were compared with respect to intra-amniotic infection and postpartum endometritis.. During the study period, 332 patients with meconium-stained AF were approached for participation, and 120 patients met inclusion criteria and were enrolled. Patient demographics, labor, and delivery characteristics were similar. Ampicillin-sulbactam reduced the incidence of intra-amniotic infection from 23.3 to 6.7%, (P = .02; relative risk [RR] 0.48, 95% confidence interval [CI] 0.22-0.98). The incidence of postpartum endometritis was also reduced, but the difference was statistically nonsignificant (8.3 versus 16.7%, P = .16; RR 0.64, 95% CI 0.30-1.33).. Prophylactic intravenous ampicillin-sulbactam significantly reduces intra-amniotic infection in patients with meconium-stained AF.

Topics: Adult; Amniotic Fluid; Ampicillin; Anti-Bacterial Agents; Bacterial Infections; Confidence Intervals; Double-Blind Method; Endometritis; Female; Fetal Diseases; Humans; Infant, Newborn; Meconium; Obstetric Labor Complications; Penicillins; Pregnancy; Risk; Sulbactam

Prophylactic cefazolin was evaluated in high-risk obstetric patients who had invasive fetal monitoring and subsequent cesarean section. A three-dose regimen of either cefazolin or placebo was administered randomly in a double-blind manner to 93 patients, 48 receiving cefazolin and 45 placebo, with the first dose given when the cord was clamped. In the placebo group, 51% of the patients were treated for endomyometritis compared to 29% in the cefazolin group. The incidence of urinary tract and wound infections was similar in the 2 groups. One patient in the active drug group was diagnosed as having septic pelvic thrombophlebitis and received multiple antibiotics and heparin before she recovered. One patient in the placebo group required triple antibiotic therapy. Operation to control infection was not required in any patients and there were no maternal deaths. The cefazolin patients had fewer degree-hours of morbidity as calculated by the quantitative fever index (P less than 0.002). The perioperative use of cefazolin was efficacious in reducing the incidence of endomyometritis, but did not prevent serious postoperative pelvic infection.

Topics: Adolescent; Adult; Amniotic Fluid; Bacterial Infections; Cefazolin; Cephalosporins; Cesarean Section; Clinical Trials as Topic; Double-Blind Method; Endometritis; Extraembryonic Membranes; Female; Fetal Monitoring; Humans; Labor, Obstetric; Meconium; Placebos; Postoperative Complications; Pregnancy; Risk; Surgical Wound Infection; Time Factors; Urinary Tract Infections

Fetal meconium peritonitis complicated by bacterial infection is extremely rare. We report a case of fetal ascites at 21 weeks of gestation with subsequent development of loculation, encapsulation, and calcification at 25 weeks. Paracentesis of loculated ascitic fluid at 28 weeks of gestation showed a purulent appearance with the presence of cocci bacteria, increase in white cell count, and a low glucose level, which were suggestive of bacterial infection. However, no sources of maternal infection could be identified. The total bilirubin level of the ascitic fluid was normal (21 micromol/L). A healthy baby was delivered at 37 weeks. CT scan revealed normal bowel without any sign of perforation. We postulate that when ascitic fluid becomes loculated, a normal bilirubin level on paracentesis indicates spontaneous closure of a previous bowel perforation.

Topics: Adult; Ascitic Fluid; Bacterial Infections; Diagnosis, Differential; Female; Fetal Diseases; Gestational Age; Humans; Meconium; Peritonitis; Pregnancy; Tomography, X-Ray Computed; Ultrasonography, Prenatal

To explore the relationship between meconium-stained amniotic fluid and Fifty-six women of cesarean section with intact membrane and intra-amniotic infection.. without parturient were divided into 3 groups according to the property of amniotic fluid (no meconium, I to approximately II degree meconium stainedness, and III degree mecomium stainedness). The content of interleukin-6 in amniotic fluid was measured with ELISA. The infiltration of inflammatory cells in the placenta and its membrane was determined by the pathological diagnosis. The neonatal Apgar score and puerperial infection after the surgery were analyzed.. There were no significant differences in the content of IL-6 in amniotic fluid and in the infiltration of inflammatory cells among the 3 groups. But the rate of neonatal asphyxia in the meconium-stained cases was significantly higher than that without meconium.. Meconium-stained amniotic fluid is a marker of fetal distress, but it is not related to intra-amniotic infection.

Topics: Adult; Amniotic Fluid; Bacterial Infections; Cesarean Section; Chorioamnionitis; Female; Fetal Distress; Fetal Monitoring; Humans; Infant, Newborn; Meconium; Meconium Aspiration Syndrome; Pregnancy; Pregnancy Complications, Infectious

To test the hypothesis that the presence of meconium-stained amniotic fluid (AF) is associated with maternal and neonatal infection, both before and after delivery.. Nine hundred thirty-six laboring women were analyzed for the presence of meconium in amniotic fluid and occurrence of peripartum infection. Meconium was assessed clinically as thin, moderate, or thick. Intra-amniotic infection and endometritis were diagnosed by standard definitions. All patients were tested for vaginal group B streptococcus, bacterial vaginosis, and other aerobic organisms.. Meconium-stained AF was present in 28% of the study participants (9% thin, 12% moderate, 7% thick). The presence of meconium was associated with increased intra-amniotic fluid (17% versus 9%, relative risk [RRI 1.98, 95% confidence interval [CI] 1.3, 3.1), endometritis (10% versus 5%, RR 2.38, 95% CI 1.3, 4.4), and total infection (25% versus 13%, RR 2.19, 95% CI 1.5, 3.2). Thick meconium had higher infection rates than clear AF (44% versus 13%, RR 5.18, 95% CI 2.9, 9.3). Meconium was associated independently with peripartum infection by multiple logistic regression (RR 1.28, 95% CI 1.1, 1.6).. Meconium-stained AF is associated with increased peripartum infection, independent of other risk factors for infection. Thick meconium, in particular, is associated with a marked increase in peripartum infectious morbidity.

Topics: Adult; Amnion; Amniotic Fluid; Bacteria; Bacterial Infections; Endometritis; Female; Humans; Meconium; Pregnancy; Pregnancy Complications, Infectious; Prospective Studies; Risk Factors; Vagina; Vaginosis, Bacterial

The objective of this study was to determine the rate of intra-amniotic infection in patients with meconium-stained amniotic fluid compared to controls. With a retrospective case-controlled study design, we compared 100 pregnant women with meconium to 100 pregnant women without meconium for the development of intra-amniotic infection. Patients delivered between September 1 and December 31, 1990. Exclusion criteria were active infection prior to labor or antibiotic use within the 7 days prior to delivery. We diagnosed clinical intra-amniotic infection in patients with ruptured membranes by a maternal temperature 100.4 degrees F or higher and any two of the following: maternal or fetal tachycardia, uterine tenderness, white blood cell count 10,500 mm3 or more, or foul-smelling amniotic fluid. Demographic variables, labor characteristics, maternal infectious morbidity, and neonatal outcome were analyzed using the Wilcoxin rank test, chi-square test, or Fisher's exact test as appropriate. The rate of clinical intra-amniotic infection was significantly higher in women with meconium-stained amniotic fluid (8%) compared with women with no meconium (2%) (p = 0.05).

Topics: Adult; Amniotic Fluid; Bacterial Infections; Female; Humans; Infant, Newborn; Meconium; Obstetric Labor Complications; Pregnancy; Pregnancy Outcome; Retrospective Studies

A retrospective study was carried out on 72 liveborn babies in whom perinatal infection was suspected. Twenty-nine of the 72 neonates were effectively infected. Analysis of intrapartum FHR recordings showed that tachycardia (base line FHR above 160 beats/min) during labor, occurred more often among infected babies (P less than 0.001). When fetal tachycardia is associated with meconium stained amniotic fluid (MSAF), the relative risk of fetal infection is 51 times as great as in babies without MSAF. Fetal tachycardia is not related to maternal fever nor to prematurity. It is not a sign of limited placental or amniotic fluid infection, but implies infection of the fetus itself. Since most infected babies displayed infectious diarrhea immediately at birth, it is suggested that MSAF may eventually be due to antenatal intestinal infection and intrauterine emission of infected stools. Although great caution is advocated for the management of labor in the presence of fetal tachycardia, MSAF should not be always regarded as a sign of acute fetal distress when antenatal infection of the fetus is suspected.

Topics: Bacterial Infections; Female; Fetal Diseases; Fetal Monitoring; Heart Rate; Humans; Infant, Newborn; Meconium; Pregnancy; Prenatal Diagnosis; Retrospective Studies; Streptococcal Infections; Tachycardia

Topics: Amniocentesis; Amniotic Fluid; Bacterial Infections; Congenital Abnormalities; Female; Fetal Diseases; Fetal Membranes, Premature Rupture; Gestational Age; Humans; Infant, Newborn; Meconium; Phospholipids; Pregnancy; Pregnancy Trimester, Third; Prenatal Diagnosis; Radiography; Respiratory Distress Syndrome, Newborn; Time Factors

Topics: Animals; Animals, Newborn; Bacterial Infections; Female; Guinea Pigs; Meconium; Peritoneum; Peritonitis; Pregnancy; Suppuration; Tissue Adhesions

Topics: Age Factors; Anal Canal; Bacterial Infections; Bacteriological Techniques; Ear, External; Escherichia coli; Eye; Humans; Infant, Newborn; Infant, Newborn, Diseases; Klebsiella pneumoniae; Listeria monocytogenes; Meconium; Moraxella; Mouth; Nose; Pharynx; Proteus; Pseudomonas aeruginosa; Skin; Staphylococcus; Stomach; Streptococcus; Umbilicus