英国伯明翰大学Dana Šumilo团队研究了剖宫产术前与脐带夹闭后预防性使用抗生素对儿童的长期影响。该研究于2022年5月17日发表在《英国医学杂志》上。

为了探讨剖宫产术前与脐带夹闭术后使用抗生素预防对5岁以下儿童健康的影响，研究组在英国初级和二级保健机构中进行了一项观察对照的中断时间序列研究。

515945名2006-2018年出生的儿童有相关孕产妇记录，并在英国两个初级保健数据库（健康改善网络和临床实践研究数据链）的一般实践中注册；在覆盖英国的医院事件统计数据库中，有7147884名有相关母亲记录的儿童，其中3945351名与报告政策改变年份的医院有关，这些医院在剖宫产术前预防性使用抗生素，而非在脐带夹闭后使用。

将出生前不久暴露于抗生素的胎儿与没有暴露的胎儿进行比较。主要结局为，当推荐使用术前预防性抗生素时，剖宫产出生的儿童哮喘和湿疹的发生率与脐带夹闭后使用抗生素的儿童哮喘和湿疹的发生率之比，并根据阴道出生的儿童发病率的时间变化进行校正。

与脐带夹闭术后使用抗生素相比，剖宫产术前使用预防性抗生素与哮喘（发病率比0.91）或湿疹（0.98）风险无显著相关性，包括5岁以下导致住院的哮喘和湿疹（分别为1.05和0.96）。

综上，该研究没有发现任何证据表明剖宫产出生的儿童术前预防性使用抗生素与儿童早期哮喘和湿疹风险之间存在关联。

附：英文原文

Title: Long term impact of prophylactic antibiotic use before incision versus after cord clamping on children born by caesarean section: longitudinal study of UK electronic health records

Author: Dana umilo, Krishnarajah Nirantharakumar, Brian H Willis, Gavin M Rudge, James Martin, Krishna Gokhale, Rasiah Thayakaran, Nicola J Adderley, Joht Singh Chandan, Kelvin Okoth, Isobel M Harris, Ruth Hewston, Magdalena Skrybant, Jonathan J Deeks, Peter Brocklehurst

Issue&Volume: 2022/05/17

Abstract:

Objective To investigate the impact on child health up to age 5 years of a policy to use antibiotic prophylaxis for caesarean section before incision compared with after cord clamping.

Design Observational controlled interrupted time series study.

Setting UK primary and secondary care.

Participants 515945 children born in 2006-18 with linked maternal records and registered with general practices contributing to two UK primary care databases (The Health Improvement Network and Clinical Practice Research Datalink), and 7147884 children with linked maternal records in the Hospital Episode Statistics database covering England, of which 3945351 were linked to hospitals that reported the year of policy change to administer prophylactic antibiotics for caesarean section before incision rather than after cord clamping.

Intervention Fetal exposure to antibiotics shortly before birth (using pre-incision antibiotic policy as proxy) compared with no exposure.

Main outcome measures The primary outcomes were incidence rate ratios of asthma and eczema in children born by caesarean section when pre-incision prophylactic antibiotics were recommended compared with those born when antibiotics were administered post-cord clamping, adjusted for temporal changes in the incidence rates in children born vaginally.

Results Prophylactic antibiotics administered before incision for caesarean section compared with after cord clamping were not associated with a significantly higher risk of asthma (incidence rate ratio 0.91, 95% confidence interval 0.78 to 1.05) or eczema (0.98, 0.94 to 1.03), including asthma and eczema resulting in hospital admission (1.05, 0.99 to 1.11 and 0.96, 0.71 to 1.29, respectively), up to age 5 years.

Conclusions This study found no evidence of an association between pre-incision prophylactic antibiotic use and risk of asthma and eczema in early childhood in children born by caesarean section.

DOI: 10.1136/bmj-2021-069704

Source: https://www.bmj.com/content/377/bmj-2021-069704