Nana Hyldig

Meta-analysis of negative-pressure wound therapy for closed surgical incisions

Postoperative wound complications are common following surgical procedures. Negative‐pressure wound therapy (NPWT) is well recognized for the management of open wounds and has been applied recently to closed surgical incisions. The evidence base to support this intervention is limited. The aim of this study was to assess whether NPWT reduces postoperative wound complications when applied to closed surgical incisions.

Timing of antibiotic prophylaxis for caesarean section

Sir, The well-conducted systematic review of Baaqeel and Baaqeel highlights the important debate on the use of prophylactic antibiotics for caesarean section. However, by their own admission, this is an update of a previous systematic review which confirms that pre-incisional rather than post-cord-clamping administration of antibiotics in women undergoing caesarean section significantly reduces the rate of postoperative maternal infectious morbidity. However, meta-analyses are only as good as the quality of studies included and such repetition may perpetuate earlier errors. Also by their own admission, the studies included were heterogeneous with respect to sample size (range 90– 741) and downgraded to only moderate quality. In their Introduction, the authors state that it was the neonatal impact that prompted them to undertake the review, yet they record that the longterm effects on the offspring ‘are beyond the scope of this review’. This contradiction may have been made in retrospect because none of the studies had long-term follow-up data. As the initial composition of the infant gut microbiota is a key determinant in the development of childhood asthma and atopic disease, long-term follow up is essential if we are to examine the correlation between preincisional administration of antibiotics and administration after cord-clamping with respect to adverse infant outcome. To overcome this problem of pooling small to medium-sized randomised controlled trials of only moderate quality, and trying to make judgements on short-term and long-term outcome of the offspring, we have initiated a large, tricentre randomised controlled trial. Our sample size calculation of 2844 exceeds the total number of the six studies quoted in Baaqeel and Baaqeel’s review. This study, in a homogeneous Scandinavian population, will be powered to show an expected reduction (>25%) of the median baseline risk of poor outcome (optimal information) with robust follow up of the children for 5 years. We are using second-generation cephalosporins (drug of choice for this indication in Scandinavia) which have a broader spectrum than the narrow range first-generation cephalosporin used in the studies within the systematic review, another aspect of the current debate on the use of prophylactic antibiotics for caesarean section. Though it is difficult to calculate a sample size sufficient to demonstrate significant changes in childhood immunity after exposure to antibiotics immediately before delivery, in our randomised controlled trial, using culture-independent molecularly based techniques, we plan to measure changes in the infant gut microbiome from birth to 6 months of age. This will be linked to the development of asthma and allergic diseases in any of the participating children at the age of 5 years through both interviews with the parents and using the Danish National Birth and Patient Registries. We hope that our study will remove the need for such meta-analyses in the future.&

Prophylactic incisional negative pressure wound therapy reduces the risk of surgical site infection after caesarean section in obese women: a pragmatic randomised clinical trial

To evaluate the reduction of surgical site infections by prophylactic incisional negative pressure wound therapy compared with standard postoperative dressings in obese women giving birth by caesarean section.

The half‐life and exposure of Cefuroxime varied in newborn infants after a Caesarean section

No information was available on how fast intravenous cefuroxime administered to pregnant women before a Caesarean section was cleared in newborn infants. This study investigated the drugs half‐life and the exposure of healthy newborn infants after their mothers received the drug.