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Beware Observational Studies in Neonatal Practice
Arch Pediatr Adolesc Med. 2003;157:934-935.
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Paul et al1 showed, in an observational study, an apparent protective effect of antepartum antibiotics on the outcome of cystic lesions detected by cranial ultrasound. I wish to underscore the concluding recommendation of the authors that their results should not alter clinical practice. Cystic echolucencies are imperfect predictors of cerebral palsy (CP), the outcome of ultimate clinical interest. Any discussion must also consider the association of maternal antibiotic use with CP. There is no conclusive evidence that antimicrobial therapy, outside its use for treating proven infections, alters that risk. Early-onset sepsis is rarely the cause of CP. There is no consensus that chorioamnionitis is associated with later CP in preterm infants when other risks are taken into account.2
The reported study is retrospective, and 5 retrospective studies3-7 have reported no association of maternal antimicrobials with later CP. Two studies report a positive association.8-9 Prospective clinical trials for the treatment of . . . [Full Text of this Article]
Rodney E. Willoughby, Jr, MD
Eudowood Division of Infectious Diseases, Department of Pediatrics
Johns Hopkins School of Medicine
Pediatric Infectious Diseases
600 N Wolfe St/Park 256
Baltimore, MD 21287
(e-mail: rwilloug@jhmi.edu)
RELATED ARTICLE
Beware Observational Studies in Neonatal Practice—Reply
Mae M. Coleman, Kathleen H. Leef, Deborah Tuttle, John L. Stefano, and David Paul
Arch Pediatr Adolesc Med. 2003;157(9):935.
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