This Scientific Impact Paper examines the evidence for giving antibiotics to asymptomatic and symptomatic women with preterm labour (with and without ruptured membranes) and whether there is a link between infection and cerebral palsy.
The risk of cerebral palsy is proportional to gestational age; the prevalence of cerebral palsy is 80 times higher in infants born prior to 28 weeks of gestation compared to those born at term, meaning that preterm birth is a risk factor for cerebral palsy. Infection is also commonly associated with preterm birth (particularly when the membranes have ruptured) and is therefore considered to contribute to the high mortality and neurological morbidity in this group.
In theory, the acute use of antibiotics could eradicate infection, prolong the pregnancy and improve neonatal outcome. Alternatively, antibiotics may suppress the infection but leave the fetus in a hostile inflammatory environment.
The evidence reviewed in this paper suggests that women with spontaneous preterm labour with intact membranes and no evidence of overt infection should not routinely be prescribed antibiotics because there is evidence that antibiotics given under these circumstances increases the risk of functional impairment and cerebral palsy.