Impact of intrapartum antibiotics on the infant gastrointestinal microbiome: a narrative review.

Abstract

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. We aimed to evaluate the impact of IPAs on the infant GI microbiome. 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 <i>Bifidobacterium</i> and <i>Lactobacillus</i>, as well as alpha and beta diversity. 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 <i>Bifidobacterium</i>, 89% (17/19) did not display any significant differences in <i>Lactobacillus</i> 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. IPAs impact the composition of the infant GI microbiome, resulting in possible reductions <i>Bifidobacterium</i> 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.