Is peripartum maternal fever alone a reliable predictor of neonatal sepsis? A single‐centre, retrospective cohort study

Abstract

Aim: To determine the incidence rate of early-onset neonatal sepsis (EONS) among term neonates (gestation greater than 37 weeks) admitted to the neonatal intensive care unit for suspected sepsis and the association of EONS with maternal fever (temperature greater than 38 C). Methods: A single-centre retrospective cohort study of all term neonates (gestation >37 weeks) admitted to and treated in the neonatal unit at the Townsville University Hospital between March 2015 and March 2020. Neonatal sepsis was confirmed with positive neonatal blood culture. Data on neonatal birth/stay and maternal pregnancy were collected from the electronic medical records and neonatal database. Results: Data from 737 neonates who were admitted for treatment of EONS were analysed. Sixty % (426) reported maternal intrapartum fever, with 1.1% (5) of neonates developing blood culture-proven sepsis. Forty % did not report intrapartum fever (311), with 3% (9) of neonates developing sepsis. As such, the sensitivity and specificity of maternal fever are 1.14% and 97%, respectively. The positive predictive value was 35.7%, and the negative predictive value was 40.1%. Fourteen neonates developed EONS, and all of them were symptomatic. Seventy-eight % (334/426) of the women in the febrile group received epidural analgesia compared to 5% (16/311) in the afebrile group. Of the 95 neonates born to women with chorioamnionitis, one (1.0%) of the neonates born to women with chorioamnionitis developed sepsis. Conclusions: Intrapartum maternal fever is an unreliable predictor for EONS and leads to unnecessary antibiotic treatment. Symptoms in the neonate are a more reliable indicator of an ill neonate with blood culture-proven sepsis.

A retrospective study of risk factors for early-onset neonatal sepsis with intrapartum maternal fever

“…In this study, the overall incidence of fever of more than 38 °C was 4.93% (592/12000), which is similar to previous studies ( Towers et al, 2017 ). The overall incidence of fever in mothers of newborns with culture-proven sepsis was 9.86% (56/568), which is much lower than other published reports ( Wortham et al, 2016 ; Gupta et al, 2021 ), likely due to non-infectious maternal fevers. This is supported by previous studies, which have reported that 40% of women with intrapartum fevers had non-infectious fevers ( Kim et al, 2015 ).…”

“…Maternal temperature increases as a result of inflammation and may also be influenced by various factors such as the activity and intensity of uterine contractions, as well as physiological changes that occur during labor such as an increase in basal metabolic rates ( Anim-Somuah et al, 2018 ). Other causes of intrapartum fever include antepartum infections, such as urinary/respiratory tract infections, and side effects from medications taken during labor ( Gupta et al, 2021 ). Antepartum and intrapartum characteristics provide important information regarding exposure to infectious diseases and inform neonatologists of obstetric risk factors for neonatal infections ( American College of Obstetricians and Gynecologists’ Task Force on Neonatal Encephalopathy, 2014 ).…”

“…Intrapartum fever is monitored to prevent the transfer of infections to newborns with immature immune systems ( Gupta et al, 2021 ). We evaluated the differences in maternal characteristics before and after delivery as well as the obstetrical and neonatal outcomes between the EOS and non-sepsis groups in this study.…”

“…Maternal fever may suggest maternal-fetal transmission of infection leading to neonatal sepsis, but it may also be non-specific. Neonates born to mothers without fever can also develop sepsis, highlighting the uncertainty of the correlation between maternal fever and EOS ( Gupta et al, 2021 ). Therefore, it may not be reasonable to routinely administer antibiotics to all newborns of mothers with fever at delivery.…”

“…Longer hospital stays for tests and treatment may lead to higher medical costs. The infant microbiome is also very sensitive, and exposure to avoidable antibiotics may have long-term health outcomes; prescribing avoidable antibiotics also impacts overall antibiotic stewardship ( Gupta et al, 2021 ).…”