Chorioamnionitis and Culture-Confirmed, Early-Onset Neonatal Infections

Author:

Wortham Jonathan M.1,Hansen Nellie I.2,Schrag Stephanie J.3,Hale Ellen45,Van Meurs Krisa6,Sánchez Pablo J.7,Cantey Joseph B.7,Faix Roger8,Poindexter Brenda9,Goldberg Ronald10,Bizzarro Matthew11,Frantz Ivan12,Das Abhik13,Benitz William E.6,Shane Andi L.45,Higgins Rosemary14,Stoll Barbara J.45,

Affiliation:

1. Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia

2. Social, Statistical, and Environmental Sciences, RTI International, Research Triangle Park, North Carolina;

3. National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia;

4. Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia;

5. Children’s Healthcare of Atlanta, Atlanta, Georgia;

6. Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine and Lucile Packard Children’s Hospital, Palo Alto, California;

7. Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, Texas;

8. Division of Neonatology, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, Utah;

9. Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana;

10. Department of Pediatrics, Duke University, Durham, North Carolina;

11. Department of Pediatrics, Yale University School of Medicine, New Haven, Connecticut;

12. Department of Pediatrics, Floating Hospital for Children, Tufts Medical Center, Boston, Massachusetts; and

13. Social, Statistical, and Environmental Sciences, RTI International, Rockville, Maryland

14. Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland

Abstract

BACKGROUND: Current guidelines for prevention of neonatal group B streptococcal disease recommend diagnostic evaluations and empirical antibiotic therapy for well-appearing, chorioamnionitis-exposed newborns. Some clinicians question these recommendations, citing the decline in early-onset group B streptococcal disease rates since widespread intrapartum antibiotic prophylaxis implementation and potential antibiotic risks. We aimed to determine whether chorioamnionitis-exposed newborns with culture-confirmed, early-onset infections can be asymptomatic at birth. METHODS: Multicenter, prospective surveillance for early-onset neonatal infections was conducted during 2006–2009. Early-onset infection was defined as isolation of a pathogen from blood or cerebrospinal fluid collected ≤72 hours after birth. Maternal chorioamnionitis was defined by clinical diagnosis in the medical record or by histologic diagnosis by placental pathology. Hospital records of newborns with early-onset infections born to mothers with chorioamnionitis were reviewed retrospectively to determine symptom onset. RESULTS: Early-onset infections were diagnosed in 389 of 396 586 live births, including 232 (60%) chorioamnionitis-exposed newborns. Records for 229 were reviewed; 29 (13%) had no documented symptoms within 6 hours of birth, including 21 (9%) who remained asymptomatic at 72 hours. Intrapartum antibiotic prophylaxis exposure did not differ significantly between asymptomatic and symptomatic infants (76% vs 69%; P = .52). Assuming complete guideline implementation, we estimated that 60 to 1400 newborns would receive diagnostic evaluations and antibiotics for each infected asymptomatic newborn, depending on chorioamnionitis prevalence. CONCLUSIONS: Some infants born to mothers with chorioamnionitis may have no signs of sepsis at birth despite having culture-confirmed infections. Implementation of current clinical guidelines may result in early diagnosis, but large numbers of uninfected asymptomatic infants would be treated.

Publisher

American Academy of Pediatrics (AAP)

Subject

Pediatrics, Perinatology, and Child Health

Cited by 118 articles. 订阅此论文施引文献 订阅此论文施引文献,注册后可以免费订阅5篇论文的施引文献,订阅后可以查看论文全部施引文献

同舟云学术

1.学者识别学者识别

2.学术分析学术分析

3.人才评估人才评估

"同舟云学术"是以全球学者为主线,采集、加工和组织学术论文而形成的新型学术文献查询和分析系统,可以对全球学者进行文献检索和人才价值评估。用户可以通过关注某些学科领域的顶尖人物而持续追踪该领域的学科进展和研究前沿。经过近期的数据扩容,当前同舟云学术共收录了国内外主流学术期刊6万余种,收集的期刊论文及会议论文总量共计约1.5亿篇,并以每天添加12000余篇中外论文的速度递增。我们也可以为用户提供个性化、定制化的学者数据。欢迎来电咨询!咨询电话:010-8811{复制后删除}0370

www.globalauthorid.com

TOP

Copyright © 2019-2024 北京同舟云网络信息技术有限公司
京公网安备11010802033243号  京ICP备18003416号-3