Management of asymptomatic neonates born in the setting of chorioamnionitis: a safety comparison of the well-baby and intensive care setting

Peterson, Dawn Taylor; Hoffman, Suma B; El-Metwally, Dina; Martino-Gomez, M; Chinta, D R; Driscoll, Colleen

doi:10.1038/jp.2017.120

Cited by 6 publications

(1 citation statement)

References 26 publications

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“…Potential benefits include promotion of bonding, reduced maternal stress, better thermoregulation, and establishment of breastfeeding. 18,19 The rate of exclusive breastfeeding at discharge in our CE infants (50.5%) was similar to the rate for all infants in our newborn nursery (56%) and among CE infants at another institution (46.1%), 28 but no improvement in breastfeeding was achieved between phase I and phase II of this project.…”

Section: Discussionsupporting

confidence: 64%

Management of Chorioamnionitis-Exposed Infants in the Newborn Nursery Using a Clinical Examination–Based Approach

Joshi

Gupta

Allan

et al. 2019

Hospital Pediatrics

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BACKGROUND: Antibiotic use in well-appearing late preterm and term chorioamnionitis-exposed (CE) infants was reduced by 88% after the adoption of a care approach that was focused on clinical monitoring in the intensive care nursery to determine the need for antibiotics. However, this approach continued to separate mothers and infants. We aimed to reduce maternal-infant separation while continuing to use a clinical examination-based approach to identify early-onset sepsis (EOS) in CE infants. METHODS: Within a quality improvement framework, well-appearing CE infants $35 weeks' gestation were monitored clinically while in couplet care in the postpartum unit without laboratory testing or empirical antibiotics. Clinical monitoring included physician examination at birth and nurse examinations every 30 minutes for 2 hours and then every 4 hours until 24 hours of life. Infants who developed clinical signs of illness were further evaluated and/or treated with antibiotics. Antibiotic use, laboratory testing, and clinical outcomes were collected. RESULTS: Among 319 initially well-appearing CE infants, 15 (4.7%) received antibiotics, 23 (7.2%) underwent laboratory testing, and 295 (92.5%) remained with their mothers in couplet care throughout the birth hospitalization. One infant had group B Streptococcus EOS identified and treated at 24 hours of age based on new-onset tachypnea and had an uncomplicated course. CONCLUSIONS: Management of well-appearing CE infants by using a clinical examination-based approach during couplet care in the postpartum unit maintained low rates of laboratory testing and antibiotic use and markedly reduced mother-infant separation without adverse events. A framework for repeated clinical assessments is an essential component of identifying infants with EOS.

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Section: Discussionsupporting

confidence: 64%