Chorioamnionitis and culture-confirmed, early-onset neonatal infections

Jonathan M. Wortham, Nellie I. Hansen, Stephanie J. Schrag, Ellen Hale, Krisa Van Meurs, Pablo J. Sánchez, Joseph B. Cantey, Roger Faix, Brenda Poindexter, Ronald Goldberg, Matthew Bizzarro, Ivan Frantz, Abhik Das, William E. Benitz, Andi L. Shane, Rosemary Higgins, Barbara J. Stoll

Research output: Contribution to journalArticle

43 Citations (Scopus)

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, earlyonset 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.

Original languageEnglish (US)
Article numbere20152323
JournalPediatrics
Volume137
Issue number1
DOIs
StatePublished - Jan 1 2016

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Chorioamnionitis
Newborn Infant
Infection
Parturition
Antibiotic Prophylaxis
Mothers
Guidelines
Anti-Bacterial Agents
Hospital Records
Live Birth
Medical Records
Cerebrospinal Fluid
Early Diagnosis
Sepsis
Pathology

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health

Cite this

Wortham, J. M., Hansen, N. I., Schrag, S. J., Hale, E., Van Meurs, K., Sánchez, P. J., ... Stoll, B. J. (2016). Chorioamnionitis and culture-confirmed, early-onset neonatal infections. Pediatrics, 137(1), [e20152323]. https://doi.org/10.1542/peds.2015-2323

Chorioamnionitis and culture-confirmed, early-onset neonatal infections. / Wortham, Jonathan M.; Hansen, Nellie I.; Schrag, Stephanie J.; Hale, Ellen; Van Meurs, Krisa; Sánchez, Pablo J.; Cantey, Joseph B.; Faix, Roger; Poindexter, Brenda; Goldberg, Ronald; Bizzarro, Matthew; Frantz, Ivan; Das, Abhik; Benitz, William E.; Shane, Andi L.; Higgins, Rosemary; Stoll, Barbara J.

In: Pediatrics, Vol. 137, No. 1, e20152323, 01.01.2016.

Research output: Contribution to journalArticle

Wortham, JM, Hansen, NI, Schrag, SJ, Hale, E, Van Meurs, K, Sánchez, PJ, Cantey, JB, Faix, R, Poindexter, B, Goldberg, R, Bizzarro, M, Frantz, I, Das, A, Benitz, WE, Shane, AL, Higgins, R & Stoll, BJ 2016, 'Chorioamnionitis and culture-confirmed, early-onset neonatal infections', Pediatrics, vol. 137, no. 1, e20152323. https://doi.org/10.1542/peds.2015-2323
Wortham JM, Hansen NI, Schrag SJ, Hale E, Van Meurs K, Sánchez PJ et al. Chorioamnionitis and culture-confirmed, early-onset neonatal infections. Pediatrics. 2016 Jan 1;137(1). e20152323. https://doi.org/10.1542/peds.2015-2323
Wortham, Jonathan M. ; Hansen, Nellie I. ; Schrag, Stephanie J. ; Hale, Ellen ; Van Meurs, Krisa ; Sánchez, Pablo J. ; Cantey, Joseph B. ; Faix, Roger ; Poindexter, Brenda ; Goldberg, Ronald ; Bizzarro, Matthew ; Frantz, Ivan ; Das, Abhik ; Benitz, William E. ; Shane, Andi L. ; Higgins, Rosemary ; Stoll, Barbara J. / Chorioamnionitis and culture-confirmed, early-onset neonatal infections. In: Pediatrics. 2016 ; Vol. 137, No. 1.
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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, earlyonset 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.",
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AU - Sánchez, Pablo J.

AU - Cantey, Joseph B.

AU - Faix, Roger

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AU - Goldberg, Ronald

AU - Bizzarro, Matthew

AU - Frantz, Ivan

AU - Das, Abhik

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AU - Stoll, Barbara J.

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N2 - 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, earlyonset 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.

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