93 A Meta-Analysis of The Use of Antibiotics for Preterm Labour with Intact Membranes (PTL), or Preterm Pre-Labour Rupture of Membranes (PPROM) in Pregancies ≤34 Weeks

Background: Chorioamnionitis (chorio) has a profound effect on neonatal outcomes, but previous meta-analyses examining therapy with antibiotics in preterm labour or PPROM, included infants near to term. We assessed the influence of prophylactic antibiotic therapy on infants ≤34 weeks GA, who are more susceptible to the complications of prematurity.Methods: Two independent reviewers conducted literature searches (including a hand search of proceedings). Eligible papers were randomized controlled trials administering oral or intravenous antibiotics for > 24 hours to pregnant mothers ≤34wks GA. Following agreement on eligibility of 22 papers, data was extracted. Prior sub-group analysis was specified for preterm labour (PTL) with intact membranes; or Preterm Prelabour Rupture of Membranes (PPROM). If possible data is shown by sub-group. Data for obstetric & Neonatal (NN) outcomes was analyzed using Revman 4.2 software. The data is presented as: Number of studies where outcomes were extractable (N St), number of subjects randomised to treatment (N Rx), number of subjects randomized to control (N C); & summarised as weighted mean differences (WMD) or Odds Ratio (OR) with 95% CI, * shows significance p< 0.05.Results: Relevant primary outcomes are grouped by presentation:Conclusion: Treatment prolongs latency in both groups, and reduces maternal and infant infections. A decrease in NN length of stay was seen. Prior Cochrane reviews suggested trends to positive impacts for neonatal outcomes, when antibiotics are used in PROM in up to 36 weeks GA. These findings are confirmed in this higher risk (≤34 week GA) group. Prior reviews show no benefit of antibiotics in PTL up to 36 week, in contrast we find in ≤34 weeks some benefits. For preterm infants ≤34 weeks, we conclude that there are significant advantages to be gained from the use of prophylactic antibiotics for both PTL and PPROM.