Neonate: Myelomeningocele/Myeloschisis — Antibiotics for Infants with Postnatal Closure — Clinical Pathway: ICU

Neonatal Myelomeningocele/Myeloschisis Clinical Pathway — ICU

Antibiotic Recommendations for Infants in the N/IICU with Myelomeningocele/Myeloschisis

General Principles

  • Antibiotic goal administration time is within 1 hour of delivery in the SDU.
  • For infants with suspected sepsis, see the N/IICU sepsis pathway for antibiotic recommendations following fetal surgery.
  • Consider ID consult for infants with suspected infections.
  • UTI prophylaxis should be started at birth for infants not receiving broad-spectrum antibiotics for another reason. For patients receiving broad-spectrum antibiotics pre-operatively or for suspected sepsis, these broad-spectrum antibiotics provide adequate coverage for UTI prophylaxis.
  • UTI prophylaxis may be discontinued if a renal/bladder ultrasound is normal and the infant does not require clean intermittent catheterization, in discussion with urology.

Postnatal Closure

Broad-spectrum Antibiotics
Immediately Following Delivery		 Antibiotics for UTI Prophylaxis
Open Defects
  • Administer to all infants until surgical closure and for 48 hours post-operatively
  • Ampicillin, IV
    • Postnatal age ≤ 7 days
    • 100 mg/kg/dose every 8 hours
  • and
  • Cefotaxime, IV
    • Postnatal age ≤ 7 days
    • 50 mg/kg/dose every 12 hours
  • Mother (+) MRSA AND infant born via vaginal delivery:
    • Vancomycin replaces ampicillin
  • Vancomycin, IV
    • Postnatal age < 7 days
    • < 1000 g: 15 mg/kg/dose every 24 hours
    • 1000-2000 g: 15 mg/kg/dose every 18 hours
    • > 2000 g: 15 mg/kg/dose every 12 hours
  • For infants receiving broad-spectrum antibiotics, start UTI prophylaxis after broad-spectrum antibiotics are discontinued (if indicated)
  • Ampicillin, IV
    • 50 mg/kg/dose every 24 hours
  • or
  • Amoxicillin, PO
    • 15 mg/kg/dose every 24 hours
    • If tolerating PO and no concern for malabsorption
Closed/Skin Covered Defects (e.g., Lipomyelomeningocele)
  • Not indicated
  • Peri-operative antibiotics per standard recommendations, if surgical intervention pursued

See the CHOP Formulary for complete drug information.