Utjecaj upotrebe antibiotika kod prijevremenog prsnuća vodenjaka na neurološke posljedice djeteta

master's thesis

• Title (english): The impact of antibiotic use in premature rupture of membranes on the neurological outcomes in children
• Author: Stjepan Bulat
• Mentor: Josip Juras (mentor)
• Committee member: Slavko Orešković (predsjednik povjerenstva)
• Committee member: Dinka Pavičić Baldani (član povjerenstva)
• Committee member: Josip Juras (član povjerenstva)
• Granter: University of Zagreb; School of Medicine; (Department of Gynecology and Obstetrics); Zagreb
• Defense date and country: 2020-07-17, Croatia
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Clinical Medical Sciences; Gynecology and Obstetrics

Abstract

Prerano prijevremeno prsnuće vodenjaka (PRVP) javlja se u 3% svih trudnoća i odgovorno je za trećinu prijevremenih porođaja, uzrokujući značajni perinatalni morbiditet i smrt fetusa. U značajnom broju slučajeva PRVP-a prisutna je infekcija, iako je to klinički ponekad teško odrediti. Malo se zna o patofiziologiji intrauterine infekcije/upale te utjecaju antibiotika na istu. Poznato je
da je intrauterina infekcija/upala značajan čimbenik rizika za razvoj neuroloških oštećenja u djece. Preventivna primjena antibiotika mogla bi eradicirati infekciju i djelovati pozitivno na ishode djece trudnica s PRVP-om, dok bi s druge strane mogla samo produljiti vrijeme latencije te suprimirati infekciju do subkliničke razine bez eradiciranja infekcije, što ostavlja fetus u nepovoljnom intrauterinom „okolišu“. Ipak, europske i američke smjernice preporučuju rutinsku primjenu antibiotika pri PRVP-u. Istraživanja pokazuju kako primjena antibiotika produljuje vrijeme latencije i poboljšava određene kratkoročne neurološke ishode poput smanjenja učestalosti abnormalnog ultrazvučnog nalaza mozga novorođenčeta pri otpustu iz bolnice, ali ne utječe značajno na perinatalni mortalitet, ne dovodi do smanjenja učestalosti prijevremenih porođaja te nema utjecaja na dugoročne neurološke posljedice kod djece. Također, smjernice za upotrebu antibiotika kod PRVP-a su u velikoj mjeri bazirane na oskudnim, niskokvalitetnim i moguće zastarjelim dokazima. Optimalni antibiotski režim i duljina trajanja primjene antibiotika još uvijek nisu ustanovljeni te su potrebna daljnja istraživanja koja bi svakako uzela u obzir promjenu u bakterijskoj rezistenciji te učestalije korištenje cefalosporina u kliničkom liječenju PRVP-a.

Abstract (english)

Preterm premature rupture of membranes (PPROM) occurs in 3% of all pregnancies and is responsible for approximately one-third of all preterm births, causing significant perinatal morbidity and fetal death. In significant number of PPROM cases there is infection present although these are sometimes difficult to determine clinically. Our knowledge of pathophysiology
of intrauterine infection/inflammation and impact of antibiotic therapy on clinical course of it is elementary. It is known that intrauterine infection/inflammation is significant risk factor for developing neurological impairment in children. Prophylactic administration of antibiotics might eradicate infection in women with PPROM and improve neonatal outcomes, on the other hand it could only increase period of latency and suppress infection to subclinical level without eradicating underlying infection, leaving fetus in unfavorable intrauterine environment. Still, the European and the American guidelines recommend routine administration of antibiotic therapy in women presenting with PPROM. Studies have shown that administration of antibiotics increases period of latency and improves certain short-term neurological outcomes such as reducing the rate of
abnormal cerebral ultrasound scan prior to discharge from hospital, but it does not reduce perinatal mortality, rate of preterm births and does not have effect on long-term neurological outcomes. Furthermore, guidelines for antibiotics administration on PPROM are largely based on deficient, low quality and possibly outdated evidence. Optimal regimen and duration of antibiotic therapy are not clear and new studies estimating changes in bacterial resistance and more common clinical use of cephalosporines in clinical management of PPROM are necessary.

• Keywords: prerano prijevremeno prsnuće vodenjaka (PRVP); antibiotici; korioamnionitis; neurološki ishodi
• Keywords (english): preterm premature rupture of membranes (PPROM); antibiotics; chorioamnionitis; neurological outcomes
• Language: croatian
• URN:NBN: urn:nbn:hr:105:568311
• Study programme: Title: Medicine; Study programme type: university; Study level: integrated undergraduate and graduate; Academic / professional title: doktor/doktorica medicine (doktor/doktorica medicine)
• Type of resource: Text
• File origin: Born digital
• Access conditions: Open access
• Created on: 2021-03-31 09:30:31