Palsy risk for premature birth antibiotics
Children born to women given antibiotics during premature labour 'twice as likely to develop cerebral palsy'
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Thursday, 18, Sep 2008 12:26
Children born to women given antibiotics during premature labour are more likely to develop cerebral palsy as a result, a study has shown.
The results from the Oracle children's study – funded by the Medical Research Council – revealed children whose mothers who did not have early broken waters were given two commonly prescribed drugs were twice as likely to develop the condition.
About three per cent of children involved in the study whose mothers had been given erythromycin or co-amoxiclav were found to have cerebral palsy when they reached seven years of age – twice the rate for children born prematurely without antibiotics.
In addition, functional impairment rates – including vision, hearing, speech, ambulation, dexterity, emotion, cognition and pain – were found to be evident in two out of five children whose mothers had been given erythromycin, about one-fifth above average.
Co-amoxiclav, on the other hand, was found to have no effect on functional impairment of the 3,196 children whose parents returned questionnaires seven years after the study started in 2001.
The original Oracle I and II trials, completed in 2001, were set up to determine whether possible underlying infection in women threatening to give birth prematurely could be tackled by the antibiotics erythromycin and co-amoxiclav, which can delay or prevent premature birth.
Although the drugs improve outcome in the short-term – the first four weeks of the baby's life – it was previously unknown whether they had any long-term effects.
"The prescription of erythromycin for women in spontaneous preterm labour with intact membranes was associated with an increase in functional impairment among their children at seven years of age," the study's authors, from the University of Leicester write in the Lancet journal.
"The risk of cerebral palsy was increased by either antibiotic, although the overall risk of this condition was low."
Commenting, Professor Philip Steer at Chelsea and Westminster hospital and Dr Alison Bedford Russell, 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. It is vital the practice is not extended by stealth beyond that which is justified by the evidence, and interventions given in pregnancy should always be evaluated with proper long-term follow-up."
But the Royal College of Obstetricians and Gynaecologists (RCOG) said the findings only applied to women who did not have pre-term pre-labour rupture of the membranes (PPROM).
"These findings do not mean that antibiotics are unsafe for use in pregnancy," an RCOG statement said.
"Pregnant women showing signs of infection should be treated promptly with antibiotics."