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Pediatrics. 2016 Jan;137(1). doi: 10.1542/peds.2015-2323. Epub 2015 Dec 30.

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

Author information

1
Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia vij5@cdc.gov.
2
Social, Statistical, and Environmental Sciences, RTI International, Research Triangle Park, North Carolina;
3
National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia;
4
Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia; Children's Healthcare of Atlanta, Atlanta, Georgia;
5
Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine and Lucile Packard Children's Hospital, Palo Alto, California;
6
Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, Texas;
7
Division of Neonatology, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, Utah;
8
Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana;
9
Department of Pediatrics, Duke University, Durham, North Carolina;
10
Department of Pediatrics, Yale University School of Medicine, New Haven, Connecticut;
11
Department of Pediatrics, Floating Hospital for Children, Tufts Medical Center, Boston, Massachusetts; and.
12
Social, Statistical, and Environmental Sciences, RTI International, Rockville, Maryland.
13
Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland.

Abstract

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.

PMID:
26719293
PMCID:
PMC4702021
DOI:
10.1542/peds.2015-2323
[Indexed for MEDLINE]
Free PMC Article

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