Risk of Early-Onset Sepsis following Preterm, Prolonged Rupture of Membranes with or without Chorioamnionitis

Abstract

Objective This study aims to determine whether preterm prolonged rupture of membranes (PPROM) increases the risk for early-onset sepsis (EOS) in preterm infants.

Study Design Retrospective cohort study of infants 30 to 34 weeks' gestation from 2005 to 2014. Exposure to PPROM (rupture of membranes ≥ 18 hours) or chorioamnionitis (maternal temperature ≥ 38°C during delivery plus notation of chorioamnionitis in the medical record) was collected. The primary outcome was proven or suspected EOS.

Results A total of 2,192 infants were included. Overall, 1,750 (80%) were not exposed to PPROM or chorioamnionitis (group 1), 381 (17%) were exposed to PPROM without chorioamnionitis (group 2), and 61 (3%) were exposed to chorioamnionitis ± PPROM (group 3). There was no difference in the incidence of proven or suspected EOS between groups 1 and 2 (5.4 vs. 5.5%, p = 0.86). Group 3 had a higher rate of EOS (24.6%) relative to groups 1 and 2 (p < 0.001). In multivariate analysis, risk of EOS was 4.1 times higher in infants exposed to chorioamnionitis. PPROM did not increase the risk of EOS in bivariate or multivariate analysis.

Conclusion In the absence of chorioamnionitis, PPROM does not increase the risk of proven or clinically suspected EOS in 30 to 34 weeks' gestation infants.

Keywords

preterm - sepsis - chorioamnionitis - prolonged rupture of membranes

Note

None of the authors have any financial disclosures or conflicts of interest in regards to the manuscript submitted.

This study was presented at the Pediatric Academic Society Annual Meeting, April 25–28, 2015, San Diego, CA.

^* Contributed equally to the article.

• References

• 1 Stoll BJ, Hansen NI, Sánchez PJ , et al; Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network Early onset neonatal sepsis: the burden of group B Streptococcal and E. coli disease continues. Pediatrics 2011; 127 (5) 817-826
• 2 Chan GJ, Lee AC, Baqui AH, Tan J, Black RE. Risk of early-onset neonatal infection with maternal infection or colonization: a global systematic review and meta-analysis. PLoS Med 2013; 10 (8) e1001502
• 3 Verani JR, McGee L, Schrag SJ , et al. Prevention of perinatal group B streptococcal disease–revised guidelines from CDC, 2010. MMWR Recommendations and reports: Morbidity and mortality weekly report Recommendations and reports/Centers for Disease Control. 2010 59(RR-10):1–36
• 4 Tsai CH, Chen YY, Wang KG, Chen CY, Chen CP. Characteristics of early-onset neonatal sepsis caused by Escherichia coli. Taiwan J Obstet Gynecol 2012; 51 (1) 26-30
• 5 Lyytikäinen O, Nuorti JP, Halmesmäki E , et al. Invasive group B streptococcal infections in Finland: a population-based study. Emerg Infect Dis 2003; 9 (4) 469-473
• 6 Mifsud AJ, Efstratiou A, Charlett A, McCartney AC ; Health Protection Agency Group B Streptococcus Working Group Early-onset neonatal group B streptococcal infection in London: 1990-1999. BJOG 2004; 111 (9) 1006-1011
• 7 Klinger G, Levy I, Sirota L, Boyko V, Reichman B, Lerner-Geva L ; Israel Neonatal Network Epidemiology and risk factors for early onset sepsis among very-low-birthweight infants. Am J Obstet Gynecol 2009; 201 (1) 38.e1-38.e6
• 8 Heath PT, Balfour GF, Tighe H, Verlander NQ, Lamagni TL, Efstratiou A ; HPA GBS Working Group Group B streptococcal disease in infants: a case control study. Arch Dis Child 2009; 94 (9) 674-680
• 9 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
• 10 Adams-Chapman I, Hansen NI, Shankaran S , et al; Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network Ten-year review of major birth defects in VLBW infants. Pediatrics 2013; 132 (1) 49-61
• 11 Greenberg MB, Anderson BL, Schulkin J, Norton ME, Aziz N. A first look at chorioamnionitis management practice variation among US obstetricians. Infect Dis Obstet Gynecol 2012; 2012: 628362
• 12 Velaphi S, Siegel JD, Wendel Jr GD, Cushion N, Eid WM, Sánchez PJ. Early-onset group B streptococcal infection after a combined maternal and neonatal group B streptococcal chemoprophylaxis strategy. Pediatrics 2003; 111 (3) 541-547
• 13 Teji JS, Srinivasan G, Pildes RS, Rydman RJ, Jacobs N. Management of asymptomatic neonates with prolonged rupture of membranes. Indian J Pediatr 1994; 61 (1) 63-69
• 14 Taylor JA, Opel DJ. Choriophobia: a 1-act play. Pediatrics 2012; 130 (2) 342-346
• 15 Benitz WE, Gould JB, Druzin ML. Antimicrobial prevention of early-onset group B streptococcal sepsis: estimates of risk reduction based on a critical literature review. Pediatrics 1999; 103 (6) e78
• 16 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
• 17 Kuppala VS, Meinzen-Derr J, Morrow AL, Schibler KR. Prolonged initial empirical antibiotic treatment is associated with adverse outcomes in premature infants. J Pediatr 2011; 159 (5) 720-725
• 18 Cantey JB, Sánchez PJ. Prolonged antibiotic therapy for “culture-negative” sepsis in preterm infants: it's time to stop!. J Pediatr 2011; 159 (5) 707-708