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Am J Perinatol 2016; 33(02): 143-150
DOI: 10.1055/s-0035-1560045
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Low Rate of Perinatal Sepsis in Term Infants of Mothers with Chorioamnionitis

David Braun
1   Regional Perinatal Services, Kaiser Permanente Southern California and Department of Pediatrics, Kaiser Permanente Southern California, Panorama City, California
,
Patricia Bromberger
2   Department of Pediatrics, San Diego Medical Center, Kaiser Permanente Southern California, San Diego, California
,
Ngoc J. Ho
3   Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California
,
Darios Getahun
3   Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California
4   Department of Obstetrics and Gynecology, Rutgers-Robert Wood Johnson Medical School, New Brunswick, New Jersey
› Author Affiliations
Further Information

Publication History

21 April 2015

29 June 2015

Publication Date:
09 September 2015 (online)

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Abstract

Objective The risk of infection in infants of mothers with chorioamnionitis (CAM) may be lower than previously reported. This study's objective was to determine the incidence of intrapartum fever (IPF) and culture-positive early-onset bacterial neonatal infection (CPEOI) in the late preterm and term infants of mothers with or without CAM and to assess interhospital variation in neonatal infection management.

Study Design This retrospective cohort study included mothers and newborns delivered at ≥35 weeks gestation at Kaiser Permanente Southern California Hospitals in 2010 (n = 31,112). Electronic medical and laboratory records from 13 medical centers were examined for maternal temperature, intrapartum, and neonatal antibiotic treatment. Rates for IPF, CAM, and CPEOI were estimated. Rates for starting neonatal antibiotics were calculated.

Results The incidence of IPF was 9% and CAM 4%. The overall rate for CPEOI was 0.61/1,000 (95% confidence interval [CI] 0.34, 0.89/1,000). The rate of CPEOI was 4.0/1,000 (95% CI 0.50, 7.5/1,000) in infants born to mothers with CAM. The rate of beginning antibiotics for infants born to mothers with CAM ranged from 7 to 76% between nurseries.

Conclusion The rate of CPEOI in infants born to mothers with CAM is lower than previously reported. There is heterogeneity in initiation of neonatal antibiotics by neonatologists.

Keywords

chorioamnionitis - neonatal infection - antibiotic use - antibiotic prophylaxis - group B streptococcus
 

  • References

  • 1 Yancey MK, Duff P, Kubilis P, Clark P, Frentzen BH. Risk factors for neonatal sepsis. Obstet Gynecol 1996; 87 (2) 188-194
    CrossrefPubMedGoogle Scholar
  • 2 Benitz WE, Gould JB, Druzin ML. Risk factors for early-onset group B streptococcal sepsis: estimation of odds ratios by critical literature review. Pediatrics 1999; 103 (6) e77
    Google Scholar
  • 3 Fassett MJ, Wing DA, Getahun D. Temporal trends in chorioamnionitis by maternal race/ethnicity and gestational age (1995-2010). Int J Reprod Med 2013; 2013: 906467
    PubMedGoogle Scholar
  • 4 Tita AT, Andrews WW. Diagnosis and management of clinical chorioamnionitis. Clin Perinatol 2010; 37 (2) 339-354
    CrossrefPubMedGoogle Scholar
  • 5 Alexander JM, McIntire DM, Leveno KJ. Chorioamnionitis and the prognosis for term infants. Obstet Gynecol 1999; 94 (2) 274-278
    CrossrefPubMedGoogle Scholar
  • 6 Soper DE, Mayhall CG, Dalton HP. Risk factors for intraamniotic infection: a prospective epidemiologic study. Am J Obstet Gynecol 1989; 161 (3) 562-566 , discussion 566–568
    CrossrefPubMedGoogle Scholar
  • 7 Jackson GL, Rawiki P, Sendelbach D, Manning MD, Engle WD. Hospital course and short-term outcomes of term and late preterm neonates following exposure to prolonged rupture of membranes and/or chorioamnionitis. Pediatr Infect Dis J 2012; 31 (1) 89-90
    CrossrefPubMedGoogle Scholar
  • 8 Yoder PR, Gibbs RS, Blanco JD, Castaneda YS, St Clair PJ. A prospective, controlled study of maternal and perinatal outcome after intra-amniotic infection at term. Am J Obstet Gynecol 1983; 145 (6) 695-701
    CrossrefPubMedGoogle Scholar
  • 9 Gilstrap III LC, Leveno KJ, Cox SM, Burris JS, Mashburn M, Rosenfeld CR. Intrapartum treatment of acute chorioamnionitis: impact on neonatal sepsis. Am J Obstet Gynecol 1988; 159 (3) 579-583
    CrossrefPubMedGoogle Scholar
  • 10 Escobar GJ, Li DK, Armstrong MA , et al. Neonatal sepsis workups in infants >/=2000 grams at birth: A population-based study. Pediatrics 2000; 106 (2 Pt 1) 256-263
    CrossrefPubMedGoogle Scholar
  • 11 Schuchat A, Zywicki SS, Dinsmoor MJ , et al. Risk factors and opportunities for prevention of early-onset neonatal sepsis: a multicenter case-control study. Pediatrics 2000; 105 (1 Pt 1) 21-26
    CrossrefPubMedGoogle Scholar
  • 12 Puopolo KM, Eichenwald EC. No change in the incidence of ampicillin-resistant, neonatal, early-onset sepsis over 18 years. Pediatrics 2010; 125 (5) e1031-e1038
    CrossrefPubMedGoogle Scholar
  • 13 van den Hoogen A, Gerards LJ, Verboon-Maciolek MA, Fleer A, Krediet TG. Long-term trends in the epidemiology of neonatal sepsis and antibiotic susceptibility of causative agents. Neonatology 2010; 97 (1) 22-28
    CrossrefPubMedGoogle Scholar
  • 14 Verani JR, McGee L, Schrag SJ ; Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention (CDC). Prevention of perinatal group B streptococcal disease—revised guidelines from CDC, 2010. MMWR Recomm Rep 2010; 59 (RR-10): 1-36
    PubMedGoogle Scholar
  • 15 Polin RA ; Committee on Fetus and Newborn. Management of neonates with suspected or proven early-onset bacterial sepsis. Pediatrics 2012; 129 (5) 1006-1015
    CrossrefPubMedGoogle Scholar
  • 16 Benitz WE, Wynn JL, Polin RA. Reappraisal of guidelines for management of neonates with suspected early-onset sepsis. J Pediatr 2015; 166 (4) 1070-1074
    CrossrefPubMedGoogle Scholar
  • 17 Haque KN. Definitions of bloodstream infection in the newborn. Pediatr Crit Care Med 2005; 6 (3, Suppl): S45-S49
    CrossrefPubMedGoogle Scholar
  • 18 Sperling RS, Ramamurthy RS, Gibbs RS. A comparison of intrapartum versus immediate postpartum treatment of intra-amniotic infection. Obstet Gynecol 1987; 70 (6) 861-865
    PubMedGoogle Scholar
  • 19 Gibbs RS, Dinsmoor MJ, Newton ER, Ramamurthy RS. A randomized trial of intrapartum versus immediate postpartum treatment of women with intra-amniotic infection. Obstet Gynecol 1988; 72 (6) 823-828
    PubMedGoogle Scholar
  • 20 Kiser C, Nawab U, McKenna K, Aghai ZH. Role of guidelines on length of therapy in chorioamnionitis and neonatal sepsis. Pediatrics 2014; 133 (6) 992-998
    CrossrefPubMedGoogle Scholar
  • 21 Lukacs SL, Schrag SJ. Clinical sepsis in neonates and young infants, United States, 1988-2006. J Pediatr 2012; 160 (6) 960-5.e1
    CrossrefPubMedGoogle Scholar
  • 22 Hauth JC, Gilstrap III LC, Hankins GD, Connor KD. Term maternal and neonatal complications of acute chorioamnionitis. Obstet Gynecol 1985; 66 (1) 59-62
    PubMedGoogle Scholar
  • 23 Rouse DJ, Landon M, Leveno KJ , et al; National Institute of Child Health And Human Development, Maternal-Fetal Medicine Units Network. The Maternal-Fetal Medicine Units cesarean registry: chorioamnionitis at term and its duration-relationship to outcomes. Am J Obstet Gynecol 2004; 191 (1) 211-216
    CrossrefPubMedGoogle Scholar
  • 24 Malloy MH. Chorioamnionitis: epidemiology of newborn management and outcome United States 2008. J Perinatol 2014; 34 (8) 611-615
    CrossrefPubMedGoogle Scholar
  • 25 Viscomi CM, Manullang T. Maternal fever, neonatal sepsis evaluation, and epidural labor analgesia. Reg Anesth Pain Med 2000; 25 (5) 549-553
    CrossrefPubMedGoogle Scholar
  • 26 Lieberman E, Lang JM, Frigoletto Jr F, Richardson DK, Ringer SA, Cohen A. Epidural analgesia, intrapartum fever, and neonatal sepsis evaluation. Pediatrics 1997; 99 (3) 415-419
    CrossrefPubMedGoogle Scholar
  • 27 Mukhopadhyay S, Eichenwald EC, Puopolo KM. Neonatal early-onset sepsis evaluations among well-appearing infants: projected impact of changes in CDC GBS guidelines. J Perinatol 2013; 33 (3) 198-205
    CrossrefPubMedGoogle Scholar
  • 28 Cordero L, Ayers LW. Duration of empiric antibiotics for suspected early-onset sepsis in extremely low birth weight infants. Infect Control Hosp Epidemiol 2003; 24 (9) 662-666
    Google Scholar
  • 29 Cotten CM, Taylor S, Stoll B , et al; NICHD Neonatal Research Network. Prolonged duration of initial empirical antibiotic treatment is associated with increased rates of necrotizing enterocolitis and death for extremely low birth weight infants. Pediatrics 2009; 123 (1) 58-66
    CrossrefPubMedGoogle Scholar
  • 30 Allen SR ; Center of Disease Control and Prevention. Management of asymptomatic term neonates whose mothers received intrapartum antibiotics—Part 2: Diagnostic tests and management strategies. Clin Pediatr (Phila) 1997; 36 (11) 617-624
    CrossrefPubMedGoogle Scholar
  • 31 Ungerer RL, Lincetto O, McGuire W, Saloojee H, Gulmezoglu AM. Prophylactic versus selective antibiotics for term newborn infants of mothers with risk factors for neonatal infection. Cochrane Database Syst Rev 2004; (4) CD003957
    PubMedGoogle Scholar
  • 32 Taylor JA, Opel DJ. Choriophobia: a 1-act play. Pediatrics 2012; 130 (2) 342-346
    CrossrefPubMedGoogle Scholar
  • 33 Cotten CM, Benjamin Jr DK, Smith PB, Stoll BJ, Spitzer AR, Clark RH. Empirical antibiotic therapy for suspected early-onset bacterial sepsis. [letter] Pediatrics 2012; 130 (4) e1052-e1053 , author reply e1055–e1057
    CrossrefPubMedGoogle Scholar
  • 34 Puopolo KM. Response to the American Academy of Pediatrics, Committee on the Fetus and Newborn statement, “management of neonates with suspected or proven early-onset bacterial sepsis”. Pediatrics 2012; 130 (4) e1054-e1055 , author reply e1055–e1057
    CrossrefPubMedGoogle Scholar
  • 35 Escobar GJ, Puopolo KM, Wi S , et al. Stratification of risk of early-onset sepsis in newborns ≥ 34 weeks' gestation. Pediatrics 2014; 133 (1) 30-36
    CrossrefPubMedGoogle Scholar
  • 36 Puopolo KM, Draper D, Wi S , et al. Estimating the probability of neonatal early-onset infection on the basis of maternal risk factors. Pediatrics 2011; 128 (5) e1155-e1163
    CrossrefPubMedGoogle Scholar