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Poster Session 1

Category: Prematurity

Poster Session 1

(108) Impact of latency antibiotic regimens on neonatal infectious morbidity

Wednesday, February 11, 2026

10:30 AM - 12:00 PM

Submitting Author and Presenting Author(s)

Alexander Boscia, MD, MS

Fellow, Maternal-Fetal Medicine
UPMC Magee-Womens Hospital
Pittsburgh, Pennsylvania, United States

Coauthor(s)

ML

Madalyn Lutz, DO

Fellow, Neonatal-Perinatal Medicine
UPMC Children's Hospital of Pittsburgh
UPMC Children's Hospital of Pittsburgh, Pennsylvania, United States
DB

Danielle Browning, DO

UPMC Children's Hospital of Pittsburgh
UPMC Children's Hospital of Pittsburgh, Pennsylvania, United States
Christina J. Megli, MD, PhD

Maternal Fetal Medicine Attending Physician
University of Pittsburgh Magee Women's Hospital
University of Pittsburgh Magee Women's Hospital, Pennsylvania, United States

Objective:
Maternal antibiotic (abx) exposure has been associated with increased rates of necrotizing enterocolitis (NEC) and late-onset sepsis (LOS). Decreased levels of mammary immunoglobulin A (mIgA) have been implicated in the development of NEC and LOS in murine models. We previously demonstrated an association between decreased mIgA and increased maternal abx exposure in human MBM samples. In the current study, we sought to demonstrate a clinical association between maternal abx exposure and neonatal infectious morbidity in patients with preterm premature rupture of membranes (PPROM). We hypothesized that nontraditional latency regimens would be associated with greater neonatal infectious morbidity. 

Study Design:
We performed a retrospective cohort study of an institutional database comprising PPROM admissions between 2015 and 2020. We included patients with expectantly-managed PPROM between 24 and 32 weeks without evidence of preterm labor. Patients were grouped into cohorts based on latency regimen: trad (ampicillin/amoxicillin), and alt - cefazolin/cephalexin (ceph) or gentamicin/clindamycin (gent/clinda). The primary outcome was a composite of LOS, NEC, and death. Results were stratified by potential confounders and subgroup analyses performed to evaluate associations between individual groups.

Results:
Of 227 infants included in the analysis, 212 and 39 were exposed to trad and alt regimens, respectively. The primary outcome occurred in 21% (trad) versus 38% (alt) of patients (p=.04). After stratification, the association remained significant for multiple categories (Table 1) including MBM exposure. Ceph regimens demonstrated increased odds of LOS compared to trad regimens (8% vs 29%, p < 0.01) that remained significant in similar categories after stratification (Table 2).

Conclusion:
Non-traditional latency regimens are associated with increased risks of a composite of neonatal infectious morbidity. Cephalosporin-based regimens specifically were associated with increased rates of LOS. These effects persisted in infants fed MBM. Larger prospective studies are needed to validate this association.