Table 5.6Evidence profile for diagnostic test accuracy of clinical chorioamnionitis, maternal fever or meconium-stained amniotic fluid for predicting early-onset neonatal infection

Number of studiesNumber of babiesSensitivity (95% confidence interval)Specificity (95% confidence interval)Positive likelihood ratio (95% confidence interval)Negative likelihood ratio (95% confidence interval)Quality
Clinical chorioamnionitis
In babies with birthweight of 500–1500 g (prediction of culture-proven infection, or clinically diagnosed pneumonia or meningitis, in the first 72 hours of life)
1 (Alexander 1998)13676.65
(5.40 to 8.16)*
79.3
(59.7 to 91.3)*
0.32
(0.15 to 0.67)*
1.18
(1.14 to 1.22)*
High
In babies < 28 weeks’ gestation or birthweight <1000 g (prediction of infection in the first 7 days of life)
1
(Ronnestad 2005)
46240.0
(22.4 to 57.5)*
77.1
(73.1 to 81.1)*
2.67
(1.52 to 4.69)*
0.76
(0.59 to 0.98)*
Moderate
In babies ≤ 32 weeks’ gestation (prediction of probable infectiona in the first 7 days of life)
1 (Martius 1999)NR50
(NC)
79
(NC)
2.38*
(NC)
0.63*
(NC)
Very low
Babies < 35 weeks’ gestation (prediction of probable infectiona in the first 7 days of life)
1 (Martius 1999)34348
(NC)
86
(NC)
3.43*
(NC)
0.60*
(NC)
Very low
Maternal fever
Fever > 37.5°C before or during labour in mothers of babies with suspected infection in the first 48 hours of life
1 (Blot 1983)7255.2
(37.1 to 73.3)*
33.3
(16.5 to 50.2)*
1.32
(0.81 to 2.13)*
0.77
(0.48 to 1.24)*
Low
Fever > 38°C in mothers of babies ≤ 32 weeks’ gestation (prediction of probable infectiona in the first 7 days of life)
1 (Martius 1999)NR11
(NC)
98
(NC)
5.50*
(NC)
0.91*
(NC)
Very low
Fever > 38°C in mothers of babies <35 weeks’ gestation (prediction of probable infectiona in the first 7 days of life)
1 (Martius 1999)3438
(NC)
98
(NC)
4.00*
(NC)
0.94*
(NC)
Very low
Meconium-stained amniotic fluid for babies with suspected infection in the first 48 hours of life
1 (Blot 1983)7275.9
(60.3 to 91.4)*
46.5
(31.6 to 61.4)*
1.42
(1.00 to 2.01)*
0.52
(0.25 to 1.97)*
Low
*

Calculated by the NCC-WCH technical team from data reported in the article

a

Probable infection based on clinical and laboratory findings

See the complete GRADE Table J 5.6

From: 5, Risk factors for infection and clinical indicators of possible infection

Cover of Antibiotics for Early-Onset Neonatal Infection
Antibiotics for Early-Onset Neonatal Infection: Antibiotics for the Prevention and Treatment of Early-Onset Neonatal Infection.
NICE Clinical Guidelines, No. 149.
National Collaborating Centre for Women's and Children's Health (UK).
London: RCOG Press; 2012 Aug.
Copyright © 2012, National Collaborating Centre for Women’s and Children’s Health.

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