Chorioamnionitis and Culture-Confirmed, Early-Onset Neonatal Infections.

Published

Journal Article

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.

Full Text

Duke Authors

Cited Authors

  • Wortham, JM; Hansen, NI; Schrag, SJ; Hale, E; Van Meurs, K; Sánchez, PJ; Cantey, JB; Faix, R; Poindexter, B; Goldberg, R; Bizzarro, M; Frantz, I; Das, A; Benitz, WE; Shane, AL; Higgins, R; Stoll, BJ; Eunice Kennedy Shriver NICHD Neonatal Research Network,

Published Date

  • January 2016

Published In

Volume / Issue

  • 137 / 1

PubMed ID

  • 26719293

Pubmed Central ID

  • 26719293

Electronic International Standard Serial Number (EISSN)

  • 1098-4275

International Standard Serial Number (ISSN)

  • 0031-4005

Digital Object Identifier (DOI)

  • 10.1542/peds.2015-2323

Language

  • eng