Association of Epidural-Related Fever and Noninfectious Inflammation in Term Labor

Riley, Laura E.; Celi, Ann C.; Onderdonk, Andrew B.; Roberts, Drucilla J.; Johnson, Lise C.; Tsen, Lawrence C.; Leffert, Lisa; Pian-Smith, May C. M.; Heffner, Linda J.; Haas, Susan; Lieberman, Ellice

doi:10.1097/aog.0b013e31820b0503

Cited by 137 publications

(75 citation statements)

References 36 publications

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“…In studies that have excluded infants with "traumatic taps" (or nonbacterial illnesses), the mean number of white blood cells in uninfected preterm or term infants was consistently <10 cells/mm 3 . [44][45][46][47][48][49][50] Cell counts 2 standard deviations from the mean were generally less than 20 cells/mm 3 . 46 In a study by Garges et al, the median number of white blood cells in infants who were born at greater than 34 weeks' gestation and had bacterial meningitis was 477/mm 3 .…”

Section: Lumbar Puncturementioning

confidence: 99%

“…[44][45][46][47][48][49][50] Cell counts 2 standard deviations from the mean were generally less than 20 cells/mm 3 . 46 In a study by Garges et al, the median number of white blood cells in infants who were born at greater than 34 weeks' gestation and had bacterial meningitis was 477/mm 3 . 43 In contrast, the median number of white blood cells in infants who were born at less than 34 weeks' gestation and had meningitis was 110/mm 3 .…”

Section: Lumbar Puncturementioning

confidence: 99%

“…Although fever is common in women who receive epidural anesthesia (15%-20%), histologic evidence of acute chorioamnionitis is very common in women who become febrile after an epidural (70.6%). 3 Furthermore, most of these women with histologic chorioamnionitis do not have a positive placental culture. 3 The incidence of clinical chorioamnionitis varies inversely with gestational age.…”

Section: Pathogenesis and Epidemiology Of Early-onset Sepsismentioning

confidence: 99%

“…3 Furthermore, most of these women with histologic chorioamnionitis do not have a positive placental culture. 3 The incidence of clinical chorioamnionitis varies inversely with gestational age. In the National Institute of Child Health and Human Development Neonatal Research Network, 14% to 28% of women delivering preterm infants at 22 through 28 weeks' gestation exhibited signs compatible with chorioamnionitis.…”

Section: Pathogenesis and Epidemiology Of Early-onset Sepsismentioning

confidence: 99%

“…Other criteria are relatively insensitive. When defining intra-amniotic infection (chorioamnionitis) for clinical research studies, the diagnosis is typically based on the presence of maternal fever of greater than 38°C (100.4°F) and at least two of the following criteria: maternal leukocytosis (greater than 15 000 cells/ mm 3 ), maternal tachycardia (greater than 100 beats/minute), fetal tachycardia (greater than 160 beats/minute), uterine tenderness, and/or foul odor of the amniotic fluid. These thresholds are associated with higher rates of neonatal and maternal morbidity.…”

Section: Pathogenesis and Epidemiology Of Early-onset Sepsismentioning

confidence: 99%

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Management of Neonates With Suspected or Proven Early-Onset Bacterial Sepsis

Polin¹,

Newborn²

2012

Pediatrics

693

433

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With improved obstetrical management and evidence-based use of intrapartum antimicrobial therapy, early-onset neonatal sepsis is becoming less frequent. However, early-onset sepsis remains one of the most common causes of neonatal morbidity and mortality in the preterm population. The identification of neonates at risk for early-onset sepsis is frequently based on a constellation of perinatal risk factors that are neither sensitive nor specific. Furthermore, diagnostic tests for neonatal sepsis have a poor positive predictive accuracy. As a result, clinicians often treat well-appearing infants for extended periods of time, even when bacterial cultures are negative. The optimal treatment of infants with suspected early-onset sepsis is broad-spectrum antimicrobial agents (ampicillin and an aminoglycoside). Once a pathogen is identified, antimicrobial therapy should be narrowed (unless synergism is needed). Recent data suggest an association between prolonged empirical treatment of preterm infants (≥5 days) with broad-spectrum antibiotics and higher risks of late onset sepsis, necrotizing enterocolitis, and mortality. To reduce these risks, antimicrobial therapy should be discontinued at 48 hours in clinical situations in which the probability of sepsis is low. The purpose of this clinical report is to provide a practical and, when possible, evidence-based approach to the management of infants with suspected or proven early-onset sepsis. Pediatrics

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Section: Lumbar Puncturementioning

confidence: 99%

Section: Lumbar Puncturementioning

confidence: 99%

Section: Pathogenesis and Epidemiology Of Early-onset Sepsismentioning

confidence: 99%

Section: Pathogenesis and Epidemiology Of Early-onset Sepsismentioning

confidence: 99%

Section: Pathogenesis and Epidemiology Of Early-onset Sepsismentioning

confidence: 99%

See 3 more Smart Citations

Management of Neonates With Suspected or Proven Early-Onset Bacterial Sepsis

Polin¹,

Newborn²

2012

Pediatrics

693

433

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Evaluation of Epidural Analgesia Use During Labor and Infection in Full-term Neonates Delivered Vaginally

et al. 2021

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Key Points Question Is epidural analgesia during labor associated with neonatal infection? Findings In this cohort study of 37 786 parturient women, epidural analgesia was associated with a higher incidence of neonatal infection than no epidural analgesia after propensity score matching. Meaning These findings suggest that there is a need for further studies to improve the safety and quality of labor and delivery care in parturient women.

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Predictive value of neutrophil‐to‐lymphocyte ratio on admission for intrapartum maternal fever in parturients undergoing epidural analgesia: A retrospective cohort study using propensity score‐matched analysis

Li,

Deng,

Sun

et al. 2024

Intl J Gynecology & Obste

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ObjectiveTo identify the predictive value of the neutrophil‐to‐lymphocyte ratio (NLR) on admission for intrapartum maternal fever in parturients undergoing epidural analgesia (EA).MethodsIn this retrospective cohort study, propensity score matching (PSM) was applied to address covariates. Univariate and multivariate regression analyses were implemented in sequence to find out the factors influencing intrapartum fever. The receiver operating characteristics curve was applied to determine the area under the curve (AUC) of NLR for intrapartum fever.ResultsNLR and duration of EA were independent risk factors for intrapartum fever. The AUC of the combined indicator (NLR + duration of EA) was higher than that of NLR (AUC = 0.583, 95% confidence interval [CI] 0.53–0.64) and duration of EA (AUC = 0.702, 95% CI 0.66–0.75), reaching 0.715 (95% CI 0.67–0.76; p < 0.001). NLR increased predictive performance for intrapartum fever when added to the duration of EA (net reclassification index 0.076, p = 0.022; integrated discrimination improvement 0.020, p = 0.002).ConclusionNLR has limited predictive power for intrapartum fever. The combination of NLR and duration of epidural analgesia may be considered a promising predictor for intrapartum maternal fever in parturients undergoing epidural analgesia.SynopsisThe neutrophil‐to‐lymphocyte ratio is an accessible predictor for the early identification of parturients at risk of intrapartum fever.

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Association of Epidural-Related Fever and Noninfectious Inflammation in Term Labor

Abstract: Epidural-related fever is rarely attributable to infection but is associated with an inflammatory state.

Cited by 137 publications

References 36 publications

Management of Neonates With Suspected or Proven Early-Onset Bacterial Sepsis

Management of Neonates With Suspected or Proven Early-Onset Bacterial Sepsis

Evaluation of Epidural Analgesia Use During Labor and Infection in Full-term Neonates Delivered Vaginally

Predictive value of neutrophil‐to‐lymphocyte ratio on admission for intrapartum maternal fever in parturients undergoing epidural analgesia: A retrospective cohort study using propensity score‐matched analysis

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