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

Publication ,  Journal Article
Wortham, JM; Hansen, NI; Schrag, SJ; Hale, E; Van Meurs, K; Sánchez, PJ; Cantey, JB; Faix, R; Poindexter, B; Goldberg, R; Bizzarro, M; Das, A ...
Published in: Pediatrics
January 2016

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.

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Published In

Pediatrics

DOI

EISSN

1098-4275

Publication Date

January 2016

Volume

137

Issue

1

Location

United States

Related Subject Headings

  • Retrospective Studies
  • Prospective Studies
  • Pregnancy
  • Pediatrics
  • Male
  • Infant, Newborn
  • Humans
  • Female
  • Chorioamnionitis
  • Bacteriological Techniques
 

Citation

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Wortham, J. M., Hansen, N. I., Schrag, S. J., Hale, E., Van Meurs, K., Sánchez, P. J., … Eunice Kennedy Shriver NICHD Neonatal Research Network. (2016). Chorioamnionitis and Culture-Confirmed, Early-Onset Neonatal Infections. Pediatrics, 137(1). https://doi.org/10.1542/peds.2015-2323
Wortham, Jonathan M., Nellie I. Hansen, Stephanie J. Schrag, Ellen Hale, Krisa Van Meurs, Pablo J. Sánchez, Joseph B. Cantey, et al. “Chorioamnionitis and Culture-Confirmed, Early-Onset Neonatal Infections.Pediatrics 137, no. 1 (January 2016). https://doi.org/10.1542/peds.2015-2323.
Wortham JM, Hansen NI, Schrag SJ, Hale E, Van Meurs K, Sánchez PJ, et al. Chorioamnionitis and Culture-Confirmed, Early-Onset Neonatal Infections. Pediatrics. 2016 Jan;137(1).
Wortham, Jonathan M., et al. “Chorioamnionitis and Culture-Confirmed, Early-Onset Neonatal Infections.Pediatrics, vol. 137, no. 1, Jan. 2016. Pubmed, doi:10.1542/peds.2015-2323.
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. Chorioamnionitis and Culture-Confirmed, Early-Onset Neonatal Infections. Pediatrics. 2016 Jan;137(1).

Published In

Pediatrics

DOI

EISSN

1098-4275

Publication Date

January 2016

Volume

137

Issue

1

Location

United States

Related Subject Headings

  • Retrospective Studies
  • Prospective Studies
  • Pregnancy
  • Pediatrics
  • Male
  • Infant, Newborn
  • Humans
  • Female
  • Chorioamnionitis
  • Bacteriological Techniques