Cerebral palsy link to antibiotics given during premature birth

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Links to The Lancet articles follow the news item

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Cerebral palsy link to antibiotics given during premature birth

Giving antibiotics to pregnant women going into premature labour

increases the risk of cerebral palsy in the child, research has

found.

, Medical Editor

18 Sep 2008

http://www.telegraph.co.uk/news/newstopics/politics/health/2975916/Cerebral-palsy-link-to-antibiotics-given-during-premature-birth.html

Children born to mothers given a combination of two antibiotics in an

attempt to stop them giving birth prematurely had an almost three fold

higher risk of developing cerebral palsy, a long term study of more than

4,000 pregnant women found.

The drugs each increased the risk when given singly but to a lesser

degree, the Oracle study carried out by the University of Leicester and

others found.

Children whose mothers had the antibiotics were also more likely to have

problems such as having to wear glasses, struggling to walk around the

block and difficulties with day to day problem solving at age

seven.

The results only apply to women who went into premature labour but whose

waters had not broken and who had no obvious signs of infection.

It was thought that a undetectable infection could have started the

labours early and doctors theorised that giving antibiotics would clear

the infection and stop a premature birth.

The Oracle study randomly assigned women going into labour to have the

antibiotics erythromycin, Co-amoxiclav, both drugs together, or a double

dummy drug. After seven years the children were followed up and in those

children born to mothers who received both drugs, 25 had cerebral palsy

or 4.4 per cent of the group compared with 12 with cerebral palsy or 1.6

per cent of those born to mothers who received dummy drugs.

Of the children born to mothers who had erythromycin 42.3 per cent had

some functional problems compared to 38.3 per cent who did not have

erythromycin, which equates to an 18 per cent increased risk.

Over 4,000 women involved in the study were asked to be kept informed of

the results and have received letters but those whose children have

problems will not know if they received the real antibiotics or the dummy

drug unless they contact the researchers.

A helpline has also been set up.

Experts said there is no risk to pregnant women taking antibiotics if

they have an infection and in those cases the drugs can be life

saving.

But doctors should not prescribe antibiotics for women with no sign of

infection when they go into premature labour and the Department of Health

has written to those in the field to inform them of the results.

It is not thought that the drugs are damaging the child rather that they

are stopping the premature labour but failing to clear an infection so

the child remains in a 'toxic environment' for longer.

Another group of women who went into premature labour but whose waters

had broken and received antibiotics showed no harmful affects.

The results were a surprise to the researchers who were expecting to find

that the short-term benefits of giving erythromycin would be translated

into long-term benefits for the children.

It is thought that doctors have already stopped prescribing antibiotics

in these situations.

In an accompanying editorial in The Lancet, Prof Philip Steer, of Chelsea

and Westminster Hospital in London and Dr Alison Bedford at

Warwick Medical School, said: " The lessons to be learned seem clear;

contrary to popular opinion (might as well give them, they don't do any

harm), antibiotics are not risk-free. There are good reasons not to give

them in association with threatened preterm labour unless there is clear

evidence of infection. "

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The Lancet: ORACLE studies

New data to inform clinical practice around preterm labour

Long-term follow-up data on the effects of antibiotics in pregnant women

experiencing premature labour and the developmental effects on their

children were published by The Lancet on Sept 18, 2008.

The original ORACLE trial published in 2001 investigated the effect of

two antibiotics given around preterm labour. The ORACLE follow-up

findings have important implications for the clinical management of

pregnant women experiencing preterm birth, and were presented at a press

conference on Sept 16, 2008.

ORACLE I: 2008

Childhood outcomes after prescription of antibiotics to pregnant women

with preterm rupture of the membranes: 7-year follow-up of the ORACLE I

trial

S Kenyon, K Pike, DR , P Brocklehurst, N Marlow, A Salt, DJ -

(DOI: 10.1016/S0140-6736(08)61202-7)

Summary

Full Text

ORACLE II: 2008

Childhood outcomes after prescription of antibiotics to pregnant women

with spontaneous preterm labour: 7-year follow-up of the ORACLE II

trial

S Kenyon, K Pike, DR , P Brocklehurst, N Marlow, A Salt, DJ -

(DOI: 10.1016/S0140-6736(08)61203-9)

Summary

Full Text

A Comment also published on Sept 18, 2008, assesses the two ORACLE

papers:

Antibiotics in preterm labour­the ORACLE speaks

AR Bedford , PJ Steer - (DOI: 10.1016/S0140-6736(08)61248-9)

Full Text

Sheri Nakken, former R.N., MA, Hahnemannian

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