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Review
Impact of intrapartum antibiotics on the infant gastrointestinal microbiome: a narrative review
  1. Laura Diamond1,
  2. Rachel Wine1,
  3. Shaun K Morris2,3
  1. 1 Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
  2. 2 Division of Infectious Diseases and Centre for Global Child Health, The Hospital for Sick Children, Toronto, Ontario, Canada
  3. 3 Department of Pediatrics, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
  1. Correspondence to Dr Shaun K Morris, Division of Infectious Diseases and Centre for Global Child Health, The Hospital for Sick Children, Toronto, ON M5G 1X8, Canada; shaun.morris{at}sickkids.ca

Abstract

Background The composition of the infant gastrointestinal (GI) microbiome has been linked to adverse long-term health outcomes and neonatal sepsis. Several factors are known to impact the composition of the microbiome, including mode of delivery, gestational age, feeding method and exposure to antibiotics. The impact of intrapartum antibiotics (IPAs) on the infant microbiome requires further research.

Objective We aimed to evaluate the impact of IPAs on the infant GI microbiome.

Methods We searched Ovid MEDLINE and Embase Classic+Embase for articles in English reporting on the microbiome of infants exposed to IPAs from the date of inception to 3 January 2021. Primary outcomes included abundance and colonisation of Bifidobacterium and Lactobacillus, as well as alpha and beta diversity.

Results 30 papers were included in this review. In the first year of life, following exposure to IPAs, 30% (6/20) of infant cohorts displayed significantly reduced Bifidobacterium, 89% (17/19) did not display any significant differences in Lactobacillus colonisation, 21% (7/34) displayed significantly reduced alpha diversity and 35% (12/34) displayed alterations in beta diversity. Results were further stratified by delivery, gestational age (preterm or full term) and feeding method.

Conclusions IPAs impact the composition of the infant GI microbiome, resulting in possible reductions Bifidobacterium and alpha diversity, and possible alterations in beta diversity. Our findings may have implications for maternal and neonatal health, including interventions to prevent reductions in health-promoting bacteria (eg, probiotics) and IPA class selection.

  • gastroenterology
  • infectious disease medicine
  • microbiology
  • neonatology
  • paediatrics

Data availability statement

Data sharing not applicable as no datasets generated and/or analysed for this study.

https://doi.org/10.1136/archdischild-2021-322590

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    Data availability statement

    Data sharing not applicable as no datasets generated and/or analysed for this study.

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    Footnotes

    • Contributors LD co-designed the research question, created the search strategy, conducted the search, extracted the data, co-analysed the data, and drafted and revised the manuscript. RW extracted data, co-analysed the data, critically appraised included articles, and drafted and revised the manuscript. SM co-designed the research question, revised search strategy development, oversaw data extraction and revised the manuscript.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

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

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.