Answer: Sepsis (Option A)
IV antibiotics administered to patients with PROM primarily reduce neonatal sepsis—this is the most direct and well-established benefit of antibiotic therapy in this clinical scenario. 1, 2
Primary Mechanism and Evidence
The American College of Obstetricians and Gynecologists provides strong evidence (GRADE 1B) that broad-spectrum antibiotic administration during expectant management of preterm PROM reduces newborn infections. 1 The primary and most direct mechanism is infection prevention through reduction of vertical bacterial transmission from mother to neonate. 2
Key Supporting Data:
Neonatal infection reduction: A Cochrane meta-analysis of over 6,000 women demonstrated that antibiotics significantly reduce neonatal infection (RR 0.68,95% CI 0.53 to 0.87). 3
Sepsis incidence: The landmark NICHD trial showed sepsis reduction was the most direct effect of antibiotic administration (8.4% vs 15.6% in GBS-negative women, P=0.01). 2
Clinical significance: Neonatal sepsis occurs in 5-25% of neonates born after PROM, making this a clinically meaningful target for intervention. 4
Why Not the Other Options?
Respiratory Distress Syndrome (Option D):
While antibiotics do show some association with reduced RDS, this is an indirect benefit mediated through pregnancy prolongation, not a direct antibiotic effect. 2 The pregnancy prolongation allows more time for fetal lung maturation and potential corticosteroid administration—the corticosteroids, not the antibiotics themselves, reduce RDS. 1
Intracranial Hemorrhage (Option C):
The Cochrane review showed reduction in abnormal cerebral ultrasound findings (RR 0.82,95% CI 0.68 to 0.98), 3 and one meta-analysis found reduced intraventricular hemorrhage in PPROM. 5 However, this benefit is less consistent and less direct than sepsis prevention. Corticosteroids, not antibiotics, are the primary intervention for reducing intraventricular hemorrhage. 1
Retinopathy (Option B):
There is no established direct relationship between maternal antibiotic administration and reduction of retinopathy of prematurity. 4
Clinical Pitfall to Avoid
Do not confuse the multiple benefits of PROM management protocols with the specific effects of antibiotics alone. While comprehensive PROM management (including antibiotics, corticosteroids, and pregnancy prolongation) improves multiple neonatal outcomes, the question asks specifically which complication is reduced by the antibiotics themselves. The answer is unequivocally sepsis. 2, 3