Download PDF
Am J Perinatol 2019; 36(04): 428-433
DOI: 10.1055/s-0038-1668548
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Infants Born to Mothers with Clinical Chorioamnionitis: A Cross-Sectional Survey on the Use of Early-Onset Sepsis Risk Calculator and Prolonged Use of Antibiotics

Marina Ayrapetyan
1   Department of Pediatrics/Neonatology, Thomas Jefferson University/Nemours, Philadelphia, Pennsylvania
,
David Carola
1   Department of Pediatrics/Neonatology, Thomas Jefferson University/Nemours, Philadelphia, Pennsylvania
,
Satyan Lakshminrusimha
2   Department of Pediatrics, University of California, Davis, California
,
Vineet Bhandari
3   Department of Neonatology, Drexel University College of Medicine, Philadelphia, Pennsylvania
,
Zubair H. Aghai
1   Department of Pediatrics/Neonatology, Thomas Jefferson University/Nemours, Philadelphia, Pennsylvania
› Author Affiliations
Funding This study was supported by the Institutional Development Award (IDeA) (Aghai) from the National Institute of General Medical Sciences of the National Institutes of Health under grant number U54-GM104941 (PI: Binder-Macleod) and NIH COBRE P30GM114736 (PI: Thomas H Shaffer).
Further Information

Publication History

20 March 2018

11 July 2018

Publication Date:
21 August 2018 (online)

Also available at
   Permissions and Reprints

Abstract

Objective To evaluate variations in practice for the management of neonates born to mothers with clinical chorioamnionitis.

Methods This was a prospective cross-sectional survey consisting of 10 multiple choice questionnaires distributed to 2,900 members of the Perinatal Section of American Academy of Pediatrics. Variations in responses were assessed and compared between the various groups.

Results A total of 682 members (23.5%) completed the survey; 169 (24.8%) indicated that they use the neonatal early-onset sepsis (EOS) risk calculator for the management of neonates born to mothers with clinical chorioamnionitis. More respondents from the western region of United States and level III units are using the EOS risk calculator compared with the south and level II units. Approximately 44% of the respondents indicated that they will not stop antibiotics at 48 to 72 hours in asymptomatic neonates born to mothers with chorioamnionitis with negative blood culture if the complete blood count (CBC) and C-reactive protein (CRP) are abnormal.

Conclusion A large number of practitioners are using the neonatal EOS risk calculator for neonates born to mothers with chorioamnionitis. Despite a clear guideline from the Committee on Fetus and Newborn, almost 44% will treat healthy-appearing neonates born to mothers with chorioamnionitis with a prolonged course of antibiotics solely for abnormal CBC or CRP.

Keywords

sepsis - neonates - EOS calculator - maternal fever
 

  • References

  • 1 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
    PubMedSearch in Google Scholar
  • 2 Polin RA. ; Committee on Fetus and Newborn. Management of neonates with suspected or proven early-onset bacterial sepsis. Pediatrics 2012; 129 (05) 1006-1015
    CrossrefPubMedSearch in Google Scholar
  • 3 Kiser C, Nawab U, McKenna K, Aghai ZH. Role of guidelines on length of therapy in chorioamnionitis and neonatal sepsis. Pediatrics 2014; 133 (06) 992-998
    CrossrefPubMedSearch in Google Scholar
  • 4 Escobar GJ, Puopolo KM, Wi S. , et al. Stratification of risk of early-onset sepsis in newborns ≥ 34 weeks' gestation. Pediatrics 2014; 133 (01) 30-36
    CrossrefPubMedSearch in Google Scholar
  • 5 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 (06) 823-828
    CrossrefPubMedSearch in Google Scholar
  • 6 Sperling RS, Ramamurthy RS, Gibbs RS. A comparison of intrapartum versus immediate postpartum treatment of intra-amniotic infection. Obstet Gynecol 1987; 70 (06) 861-865
    PubMedSearch in Google Scholar
  • 7 Hsu KK, Pelton SI, Shapiro DS. Detection of group B streptococcal bacteremia in simulated intrapartum antimicrobial prophylaxis. Diagn Microbiol Infect Dis 2003; 45 (01) 23-27
    CrossrefPubMedSearch in Google Scholar
  • 8 Shakib J, Buchi K, Smith E, Young PC. Management of newborns born to mothers with chorioamnionitis: is it time for a kinder, gentler approach?. Acad Pediatr 2015; 15 (03) 340-344
    CrossrefPubMedSearch in Google Scholar
  • 9 Polin RA, Watterberg K, Benitz W, Eichenwald E. The conundrum of early-onset sepsis. Pediatrics 2014; 133 (06) 1122-1123
    CrossrefPubMedSearch in Google Scholar
  • 10 Carola D, Vasconcellos M, Sloane A. , et al. Utility of early-onset sepsis risk calculator for neonates born to mothers with chorioamnionitis. J Pediatr 2018; 195: 48-52
    CrossrefPubMedSearch in Google Scholar
  • 11 Money N, Newman J, Demissie S, Roth P, Blau J. Anti-microbial stewardship: antibiotic use in well-appearing term neonates born to mothers with chorioamnionitis. J Perinatol 2017; 37 (12) 1304-1309
    CrossrefPubMedSearch in Google Scholar
  • 12 Alm B, Erdes L, Möllborg P. , et al. Neonatal antibiotic treatment is a risk factor for early wheezing. Pediatrics 2008; 121 (04) 697-702
    CrossrefPubMedSearch in Google Scholar
  • 13 Hviid A, Svanström H, Frisch M. Antibiotic use and inflammatory bowel diseases in childhood. Gut 2011; 60 (01) 49-54
    CrossrefPubMedSearch in Google Scholar
  • 14 Bailey LC, Forrest CB, Zhang P, Richards TM, Livshits A, DeRusso PA. Association of antibiotics in infancy with early childhood obesity. JAMA Pediatr 2014; 168 (11) 1063-1069
    CrossrefPubMedSearch in Google Scholar
  • 15 Kuzniewicz MW, Puopolo KM, Fischer A. , et al. A quantitative, risk-based approach to the management of neonatal early-onset sepsis. JAMA Pediatr 2017; 171 (04) 365-371
    CrossrefPubMedSearch in Google Scholar
  • 16 Rajbhandari S, La Gamma EF. Early-onset sepsis calculator-risk of delaying treatment. JAMA Pediatr 2017; 171 (10) 1015
    PubMedSearch in Google Scholar
  • 17 Kerste M, Corver J, Sonnevelt MC. , et al. Application of sepsis calculator in newborns with suspected infection. J Matern Fetal Neonatal Med 2016; 29 (23) 3860-3865
    CrossrefPubMedSearch in Google Scholar
  • 18 Mukhopadhyay S, Taylor JA, Von Kohorn I. , et al. Variation in sepsis evaluation across a national network of nurseries. Pediatrics 2017; 139 (03) e20162845
    CrossrefPubMedSearch in Google Scholar
  • 19 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
    CrossrefPubMedSearch in Google Scholar
  • 20 Gerdes JS, Polin RA. Sepsis screen in neonates with evaluation of plasma fibronectin. Pediatr Infect Dis J 1987; 6 (05) 443-446
    CrossrefPubMedSearch in Google Scholar
  • 21 Benitz WE, Han MY, Madan A, Ramachandra P. Serial serum C-reactive protein levels in the diagnosis of neonatal infection. Pediatrics 1998; 102 (04) E41
    CrossrefPubMedSearch in Google Scholar
  • 22 Benitz WE, Wynn JL, Polin RA. Reappraisal of guidelines for management of neonates with suspected early-onset sepsis. J Pediatr 2015; 166 (04) 1070-1074
    CrossrefPubMedSearch in Google Scholar
  • 23 Bhandari V. Effective biomarkers for diagnosis of neonatal sepsis. J Pediatric Infect Dis Soc 2014; 3 (03) 234-245
    CrossrefPubMedSearch in Google Scholar
  • 24 Cantey JB, Baird SD. Ending the culture of culture-negative sepsis in the neonatal ICU. Pediatrics 2017; 140 (04) e20170044
    CrossrefPubMedSearch in Google Scholar