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Simplified management protocol for term neonates after prolonged rupture of membranes in a setting with high rates of neonatal sepsis and mortality: a quality improvement study
  1. Diana Olita’a1,
  2. Roland Barnabas1,
  3. Gamini Vali Boma1,
  4. Wendy Pameh2,
  5. John Vince2,
  6. Trevor Duke2,3
  1. 1 Department of Paediatrics, Port Moresby General Hospital, Port Moresby, Papua New Guinea
  2. 2 School of Medicine and Health Sciences, University of Papua New Guinea, Port Moresby, Papua New Guinea
  3. 3 Centre for International Child Health, Royal Children’s Hospital, University of Melbourne, MCRI, Parkville, Victoria, Australia
  1. Correspondence to Prof Trevor Duke, Centre for International Child Health, Royal Children’s Hospital, University of Melbourne, Parkville VIC 3052, Australia; trevor.duke{at}


In low-income and middle-income countries, courses of antibiotics are routinely given to term newborns whose mothers had prolonged rupture of membranes (PROM). Rational antibiotic use is vital given rising rates of antimicrobial resistance and potential adverse effects of antibiotic exposure in newborns. However missing cases of sepsis can be life-threatening.This is a quality improvement evaluation of a protocol for minimal or no antibiotics in term babies born after PROM in Papua New Guinea. Asymptomatic, term babies born to women with PROM >12 hours prior to birth were given a stat dose of antibiotics, or no antibiotics if the mother had received intrapartum antibiotics, reviewed and discharged at 48–72 hours with follow-up. Clinical signs of sepsis within the first week and the neonatal period were assessed. Of 170 newborns whose mothers had PROM, 133 were assessed at 7 days: signs of sepsis occurred in 10 babies (7.5%; 95% CI 4.4% to 13.2%) in the first week. Five had isolated fever, four had skin pustules and one had fever with periumbilical erythema. An additional four (3%) had any sign of sepsis between 8 and 28 days. There was one case of bacteraemia and no deaths. 37 were lost to follow-up, but hospital records did not identify any subsequent admissions for infection. A rate of sepsis was documented that was comparable with other studies in low-income countries. This protocol may reduce antimicrobial resistance and consequences of antibiotic exposure in newborns, provided safeguards are in place to monitor for signs of sepsis.

  • prolonged rupture of membranes
  • neonatal sepsis
  • low and middle income country
  • quality improvement
  • antibiotic resistance

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  • Patient consent for publication Not required.

  • Contributors DO, TD, GVB and RB designed the study, supervised by the other authors. DO recruited the patients and collected the data. DO and TD analysed the data. DO wrote the first draft of the manuscript with input from TD and JV. Subsequent drafts were reviewed and revised by all authors.

  • Funding This study was funded by The RE Ross Trust through the PNG and Pacific child health training and research fellowship.

  • Competing interests None declared.

  • Ethics approval The study was approved by the University of Papua New Guinea School of Medicine and Health Sciences Medical Research Ethics Committee. The study was carefully explained to all mothers who were eligible, and informed consent for participation was gained before enrolment.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Author note Dr Wendy Pameh passed away after this study was completed.

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