What neonatal complication will be reduced in a 32-year-old gravida 3 (G3) woman at 33 weeks gestation, presenting with premature rupture of membranes (PROM) for 4 hours, no uterine contractions, and vital stability, after administration of intravenous (IV) antibiotics?

Neonatal Sepsis Reduction with IV Antibiotics in PPROM

The primary neonatal complication reduced by IV antibiotics in this clinical scenario is sepsis (Answer A). 1, 2, 3

Evidence for Sepsis Reduction

Intrapartum antibiotic prophylaxis provides 86-89% effectiveness in preventing early-onset neonatal sepsis among infants born to women who received prophylaxis, with antibiotics demonstrating a statistically significant reduction in neonatal infection (RR 0.67,95% CI 0.52-0.85) and positive blood cultures (RR 0.75,95% CI 0.60-0.93). 2, 4

• At 33 weeks gestation with PPROM, the American College of Obstetricians and Gynecologists supports antibiotic benefit as well-established, with a GRADE 1B recommendation for ≥24 weeks gestation. 1

• The Society for Maternal-Fetal Medicine acknowledges the established benefit of antibiotics at 33 weeks gestation, with the strongest evidence for benefit at earlier gestational ages (<32 weeks) but remaining applicable at 33 weeks. 1

• A landmark randomized controlled trial demonstrated that the composite primary outcome (including sepsis, respiratory distress, severe intraventricular hemorrhage, necrotizing enterocolitis, or death) was significantly reduced with antibiotics (44.1% vs 52.9%; P=0.04), with overall sepsis specifically reduced (8.4% vs 15.6%; P=0.01) in GBS-negative women. 3

Why Other Options Are Incorrect

Retinopathy (Option B): Antibiotics have no demonstrated link to reduction in retinopathy of prematurity, which is primarily related to oxygen exposure and prematurity itself, not infection prevention. 2

Intracranial hemorrhage (Option C): While some studies suggest antibiotics may reduce intraventricular hemorrhage, this finding is less consistently demonstrated across guidelines compared to sepsis reduction, and major guidelines do not emphasize hemorrhage prevention as a primary benefit of antibiotics. 2

Respiratory distress syndrome (Option D): Antibiotics have no significant effect on RDS prevention—this requires antenatal corticosteroids, not antibiotics. 2 Although one trial showed reduced respiratory distress (40.5% vs 48.7%; P=0.04), this likely reflects reduced infectious complications rather than direct RDS prevention. 3

Recommended Antibiotic Regimen

The American College of Obstetricians and Gynecologists recommends ampicillin 2g IV every 6 hours plus erythromycin 250mg IV every 6 hours for 48 hours, followed by oral amoxicillin 250mg every 8 hours plus erythromycin 333mg every 8 hours for 5 days as an evidence-based approach for PPROM patients. 1

• This regimen was used in the largest PPROM randomized controlled trials that showed decreased maternal and neonatal morbidity. 5

• Amoxicillin-clavulanic acid should be avoided because of an increased risk of necrotizing enterocolitis in neonates (RR 4.60,95% CI 1.98-10.72). 5, 4

Critical Clinical Pitfalls

Do not delay antibiotic administration beyond what is necessary to establish IV access—infection can progress rapidly without obvious symptoms, and clinical signs may be less overt at preterm gestational ages. 2

Do not wait for maternal fever to diagnose infection—intraamniotic infection may present without fever, especially at preterm gestational ages, and the absence of fever should not provide false reassurance. 2