Objective To investigate the impact on child health up to age 5 years of a policy to use antibiotic prophylaxis for caesarean section before incision compared with after cord clamping. Design Observational controlled interrupted time series study. Setting UK primary and secondary care. Participants 515 945 children born in 2006-18 with linked maternal records and registered with general practices contributing to two UK primary care databases (The Health Improvement Network and Clinical Practice Research Datalink), and 7 147 884 children with linked maternal records in the Hospital Episode Statistics database covering England, of which 3 945 351 were linked to hospitals that reported the year of policy change to administer prophylactic antibiotics for caesarean section before incision rather than after cord clamping. Intervention Fetal exposure to antibiotics shortly before birth (using pre-incision antibiotic policy as proxy) compared with no exposure. Main outcome measures The primary outcomes were incidence rate ratios of asthma and eczema in children born by caesarean section when pre-incision prophylactic antibiotics were recommended compared with those born when antibiotics were administered post-cord clamping, adjusted for temporal changes in the incidence rates in children born vaginally. Results Prophylactic antibiotics administered before incision for caesarean section compared with after cord clamping were not associated with a significantly higher risk of asthma (incidence rate ratio 0.91, 95% confidence interval 0.78 to 1.05) or eczema (0.98, 0.94 to 1.03), including asthma and eczema resulting in hospital admission (1.05, 0.99 to 1.11 and 0.96, 0.71 to 1.29, respectively), up to age 5 years. Conclusions This study found no evidence of an association between pre-incision prophylactic antibiotic use and risk of asthma and eczema in early childhood in children born by caesarean section. Data for this study were derived from Clinical Practice Research Datalink GOLD and The Health Improvement Network primary care and secondary care linked databases obtained under license from the UK Medicines and Healthcare Products Regulatory Agency and IQVIA World Publications. A separate secondary care database was derived from Hospital Episode Statistics data obtained under licence from the Health and Social Care Information Centre (NHS Digital). Data for similar cohorts can be requested from the UK Medicines and Healthcare Products Regulatory Agency, IQVIA World Publications, and NHS Digital subject to protocol approval and license agreements.

中文翻译：

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切开前预防性使用抗生素与脐带夹紧后对剖腹产婴儿的长期影响：英国电子健康记录的纵向研究

目的 调查与脐带钳夹后相比，在剖腹产手术中预防性使用抗生素的政策对 5 岁以下儿童健康的影响。设计观察性受控中断时间序列研究。设置英国初级和二级保健。参与者 2006-18 年出生的 515 945 名儿童有关联的产妇记录，并在为两个英国初级保健数据库（健康改善网络和临床实践研究数据链）做出贡献的全科诊所注册，以及 7 147 884 名在医院事件中有关联的产妇记录的儿童涵盖英格兰的统计数据库，其中 3 945 351 家与报告政策变化的医院相关联，这些医院在剖腹产手术切开前而不是脐带钳夹后使用预防性抗生素。干预 胎儿在出生前不久接触抗生素（使用切开前抗生素政策作为代理）与未接触相比。主要结局指标 主要结局是剖腹产时推荐使用预防性抗生素的剖腹产婴儿与脐带钳夹后使用抗生素时剖腹产婴儿的哮喘和湿疹发病率比率，并根据发生率的时间变化进行了调整阴道分娩的孩子。结果 与脐带钳夹后相比，剖腹产切口前预防性使用抗生素与哮喘（发病率比 0.91，95% 置信区间 0.78 至 1.05）或湿疹（0.98，0.94 至 1.03）风险显着升高无关，包括哮喘和湿疹导致入院（1.05，0.99 至 1.11 和 0.96，0.71 至 1.29，分别），直至 5 岁。结论 本研究未发现剖腹产婴儿切口前预防性抗生素使用与儿童早期哮喘和湿疹风险之间存在关联的证据。本研究的数据来自临床实践研究数据链 GOLD 和健康改善网络初级保健和二级保健链接数据库，这些数据库是在英国药品和保健产品监管机构和 IQVIA 世界出版物的许可下获得的。一个单独的二级护理数据库源自医院事件统计数据，该数据是根据健康和社会护理信息中心 (NHS Digital) 的许可获得的。可向英国药品和保健产品监管机构、IQVIA World Publications 索取类似队列的数据，