Intrapartum treatment of acute chorioamnionitis: Impact on neonatal sepsis

Gilstrap, Larry C.; Leveno, Kenneth J.; Cox, Susan M.; Burris, Jody; Mashburn, Melinda; Rosenfeld, Charles R.

doi:10.1016/s0002-9378(88)80012-7

Cited by 118 publications

(50 citation statements)

References 3 publications

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“…17 Ascertainment error is of particular concern for retrospective studies, of which only three are considered in these analyses. 46,56,93 Errors attributable to ascertainment bias are likely to be few for the studies in which blood cultures were performed uniformly on all enrolled infants 48,57,69,94,98 . In one study, blood cultures were obtained routinely from infants who received postpartum penicillin prophylaxis, but not from infants reported as historical control subjects, 90 creating the potential for overascertainment in the penicillin-treated group.…”

Section: Discussionmentioning

confidence: 99%

“…There are no reliable strategies for recognition of underreporting of negative trials. The effects of interventions on neonatal mortality secondary to early-onset sepsis are described in only a few studies including those of treatment of chorioamnionitis, 56,57,98 preterm premature rupture of membranes, 47,49 -52 postpartum prophylaxis, 23,91,92 and combined intrapartum and postpartum prophylaxis. 69 Only the very large dataset of Siegel et al included enough subjects to detect an effect on mortality rate, 23 and only one study gathered empirical data on infection-related morbidity and cost.…”

Section: Discussionmentioning

confidence: 99%

“…Gilstrap et al retrospectively examined outcomes of infants born to women with chorioamnionitis diagnosed using similar criteria. 56 Infants born to women who had been given antibiotics before delivery were less likely to have GBS bacteremia, but there was no significant effect on the total bacteremia rate ( Table 2). Gibbs et al prospectively randomized women with chorioamnionitis, diagnosed as above, to treatment during labor or only after cord clamping.…”

Section: Intrapartum Treatment Of Chorioamnionitismentioning

confidence: 98%

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Antimicrobial Prevention of Early-onset Group B Streptococcal Sepsis: Estimates of Risk Reduction Based on a Critical Literature Review

1999

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ABSTRACT. Objective. To identify interventions that reduce the attack rate for early-onset group B streptococcal (GBS) sepsis in neonates.Study Design. Literature review and reanalysis of published data.Results. The rate of early-onset GBS sepsis in highrisk neonates can be reduced by administration of antibiotics. Treatment during pregnancy (antepartum prophylaxis) fails to reduce maternal GBS colonization at delivery. With the administration of intravenous ampicillin, the risk of early-onset infection in infants born to women with preterm premature rupture of membranes is reduced by 56% and the risk of GBS infection is reduced by 36%; addition of gentamicin may increase the efficacy of ampicillin. Treatment of women with chorioamnionitis with ampicillin and gentamicin during labor reduces the likelihood of neonatal sepsis by 82% and reduces the likelihood of GBS infection by 86%. Universal administration of penicillin to neonates shortly after birth (postpartum prophylaxis) reduces the early-onset GBS attack rate by 68% but is associated with a 40% increase in overall mortality and therefore is contraindicated. Intrapartum prophylaxis, alone or combined with postnatal prophylaxis for the infants, reduces the early-onset GBS attack rate by 80% or 95%, respectively.Conclusions. Women with chorioamnionitis or preterm premature rupture of membranes and their infants should be treated with intravenous ampicillin and gentamicin. Intrapartum antimicrobial prophylaxis may be appropriate for other women whose infants are at increased but less extreme risk, and supplemental postpartum prophylaxis may be indicated for some of their infants. Selection of appropriate candidates and prophylaxis strategies requires careful consideration of costs and benefits for each patient. Pediatrics 1999;103(6). URL: http://www.pediatrics.org/cgi/content/full/103/6/e78; group B streptococcus, neonatal sepsis, early-onset sepsis, prevention, prophylaxis.ABBREVIATIONS. EOGBS, early-onset neonatal group B streptococcus infection; AAP, American Academy of Pediatrics; ACOG, American College of Obstetricians and Gynecologists; CDC, Centers for Disease Control and Prevention; GBS, group B streptococcus. P revention of early-onset neonatal group B streptococcal (EOGBS) sepsis requires the identification of infants who are at high risk and the use of effective preventive intervention. The American Academy of Pediatrics (AAP), 1,2 American College of Obstetricians and Gynecologists (ACOG), 3,4 and Centers for Disease Control and Prevention (CDC) 5 agree that this intervention should be intrapartum antibiotic treatment. The commentaries that accompany those recommendations and several recent cost-benefit or efficacy analyses implicitly 1-7 or explicitly 8 -11 assume that intrapartum antimicrobial prophylaxis is 100% effective, but reports of at least 50 cases of EOGBS disease in infants whose mothers received intrapartum prophylaxis [12][13][14][15] demonstrate that this cannot be correct. The decision analysis cited by the CDC recommendations 1...

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Intrapartum Treatment Of Chorioamnionitismentioning

confidence: 98%

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Antimicrobial Prevention of Early-onset Group B Streptococcal Sepsis: Estimates of Risk Reduction Based on a Critical Literature Review

1999

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“…Maternofetal infection is considered to be the leading cause of death during the neonatal period, particularly because of the resulting prematurity (14,34,35). The strategy to adopt in cases of chorioamnionitis remains controversial, but physicians are likely either to continue the pregnancy under maternal antibiotic therapy or terminate it and treat the newborn ex utero, despite the risks related to extreme prematurity (13,15,17,28).…”

mentioning

confidence: 99%

Persistent Bacteremia in Rabbit Fetuses despite Maternal Antibiotic Therapy in a Novel Intrauterine-Infection Model

Guen

Debillon

Toquet

et al. 2003

Antimicrob Agents Chemother

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The effect of optimized maternal therapy by bactericidal agents was evaluated in a reproducible rabbit model of Escherichia coli maternofetal infection simulating human pharmacokinetics. Intravenous antibiotic therapy was begun in the pregnant rabbit 12 h after bacterial intrauterine inoculation, using a computer-controlled pump to simulate human pharmacokinetics of ceftriaxone (1 g/day) associated or not with gentamicin (3 mg/kg of body weight/day). Data were compared for fetal survival, quantitative blood cultures, fetal histology in treated versus untreated groups, and maternal and fetal antibiotic concentrations in plasma in treated animals. Antibiotic therapy led to dramatic improvement in maternal outcome (100% survival versus 100% death in the untreated group in association with maternal septicemia). Fetal survival also improved, with the two-drug combination providing a more potent effect. After 3 days of treatment, 32% of fetuses survived with one-drug therapy and 62% with two-drug therapy (Yates corrected 2 , P < 0.05). In untreated animals, bacterial counts in blood cultures increased rapidly during the first 24 h up to 8.1 ؎ 0.5 log CFU/ml, but remained relatively constant at all times with antibiotic treatment: 4.5 ؎ 0.7 log CFU/ml at the start of treatment and 6.2 ؎ 0.4 and 5.2 ؎ 0.9 log CFU/ml after 72 h for one-and two-drug therapy, respectively (data are means ؎ standard deviations). The failure of animals to be cured after 3 days of treatment was not due to an inadequate concentration of ceftriaxone, as the residual level in fetal serum at sacrifice was more than 1,000 times the MIC of the microbe. Unexpectedly, inflammation in fetal lung decreased in the treated group after as little as 24 h of antibiotic therapy, despite persistent bacteremia. Although maternal outcome improved and drug concentrations were above the MIC, the treatment did not achieve sterilization of fetuses in utero for this rabbit E. coli maternofetal infection. However, fetal survival showed some improvement, and the histologic features of lung inflammation were reduced.

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“…Maternal data collected included: age, duration of rupture of membranes, temperature at delivery, white blood cell counts, urine analysis, and the presence or absence of uterine tenderness or purulent vaginal discharge, and fetal heart rates. The diagnosis of chorioamnionitis was made by the attending obstetrician, based on the 'Gilstrap criteria', which include a maternal temperature 1 38.2°C, fetal HR 1 160, and uterine tenderness [14]. The study was performed in accordance with a protocol approved by the Institutional Review Board of the University of Florida, and parental consent was obtained for all infants.…”

Section: Patient Populationmentioning

confidence: 99%

Granulocyte Colony-Stimulating Factor, Granulocyte Macrophage Colony-Stimulating Factor and Neutrophils in the Bronchoalveolar Lavage Fluid of Premature Infants with Respiratory Distress Syndrome

Papoff

Christensen²,

Calhoun³

et al. 2001

Neonatology

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Background: Granulocyte colony-stimulating factor (G-CSF) and granulocyte macrophage colony-stimulating factor (GM-CSF) promote clonal maturation of neutrophil and macrophage progenitors and increase functional activities of mature cells. The number and activity of neutrophils and macrophages in the lung affect healing and remodeling following respiratory distress syndrome (RDS). Questions of the Study: (1) Are G-CSF and GM-CSF present in the airways of preterm neonates with RDS? (2) Do airway G-CSF and GM-CSF concentrations correlate with neutrophil and macrophage number in the bronchoalveolar lavage (BAL) fluid? (3) Are alveolar macrophages a source of airway G-CSF and GM-CSF? (4) Is in vitro expression of G-CSF and GM-CSF by airway macrophages modified by dexamethasone, endotoxin, or hyperoxia? Methods: Eighteen preterm neonates with RDS requiring mechanical ventilation within the first 24 h of life underwent BAL on days 1, 3, 6, 10, 12, 15, 20, and 28 if still intubated. BAL G-CSF and GM-CSF concentrations were measured by ELISA, and neutrophils and macrophages were counted. Alveolar macrophages were cultured, and G-CSF and GM-CSF expression measured in the presence and absence of dexamethasone, endotoxin, and hyperoxia. Results: G-CSF and GM-CSF were present in the BAL of intubated preterm neonates. In infants who did not develop chronic lung disease (CLD) (n = 5), G-CSF and GM-CSF concentrations were highest in the first days of life, falling thereafter, while in those who did develop CLD (n = 13) these concentrations increased over time. Neutrophil concentrations in BAL fluid followed a similar pattern. Macrophages from BAL were identified as a source of G-CSF and GM-CSF mRNA and protein. G-CSF and GM-CSF expression by these macrophages was increased by endotoxin, decreased by dexamethasone, and unchanged by hyperoxia. Conclusions: G-CSF and GM-CSF are present in neonatal BAL, and may contribute significantly to the accumulation of alveolar neutrophils.

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Intrapartum treatment of acute chorioamnionitis: Impact on neonatal sepsis

Cited by 118 publications

References 3 publications

Antimicrobial Prevention of Early-onset Group B Streptococcal Sepsis: Estimates of Risk Reduction Based on a Critical Literature Review

Antimicrobial Prevention of Early-onset Group B Streptococcal Sepsis: Estimates of Risk Reduction Based on a Critical Literature Review

Persistent Bacteremia in Rabbit Fetuses despite Maternal Antibiotic Therapy in a Novel Intrauterine-Infection Model

Granulocyte Colony-Stimulating Factor, Granulocyte Macrophage Colony-Stimulating Factor and Neutrophils in the Bronchoalveolar Lavage Fluid of Premature Infants with Respiratory Distress Syndrome

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