Risk factors for neonatal sepsis in offspring of women with prelabor rupture of the membranes at 34-42 weeks

Abstract

One thousand three hundred eighty-five women with PROM (prelabor rupture of the membranes) participated in a prospective randomized study. Women with PROM were randomized to induction the following morning after PROM (early induction group) or induction two days later (late induction group). If contractions started within 2 hours after admission these women were included in the short latency group. All neonatal infections were classified as verified sepsis (positive culture) or clinical sepsis. The aim of the study was to compare the perinatal infectious outcome between the groups with different expectant managements in women with PROM and to study the association between demographic, intrapartum and postpartum variables and neonatal sepsis. In the short latency group one neonate had a proven sepsis while four neonates with proven sepsis were found in the early induction group. No proven sepsis was detected in the late induction group. Univariate analyses showed a significant association between clinical sepsis and: induction of labor (OR = 2.94, 95% CI 1.30-6.68), established labor 24.1-32 hours after ROM (OR = 5.89, 95% CI 1.68-20.63), established labor > 32 hours after ROM (OR = 4.59, 95% CI 1.52-13.87), time from ROM to delivery > 32 hours (OR = 5.07, 95% CI 1.40-18.39), cesarean section (OR = 11.03, 95% CI 4.10-29.68), chorioamnionitis before or during delivery (OR = 27.14, 95% CI 2.38-309.16), endometritis (OR = 18.08, 95% CI 1.82-179.87), CRP over 20 mg/l in the umbilical cord (OR = 17.12, 95% CI 5.68-52.12) and Apgar score < 7 after 1, 5 or 10 minutes. In a stepwise logistic regression analysis a significant association was found between clinical sepsis and cesarean section (OR = 10.08, 95% CI = 3.26-31.20), time from ROM to delivery > 32 h (OR = 3.74, 95% CI 1.62-8.62), gestational age 34-36 weeks (OR = 3.16, 95% CI 1.11-8.96) and parous women (OR = 2.41, 95% CI 1.04-5.57). In conclusion, this study indicates that that there was no difference in the incidence of neonatal infections between those with early and late induction. Clinical neonatal sepsis was associated with time from PROM to delivery over 32 hours, cesarean section, parous women and gestational age between 34 and 36 weeks.

Time Between Membrane Rupture and Delivery and Septicemia in Term Neonates

“…1,13 The finding that the offspring of primiparous mothers more often had sepsis is in agreement with TrijbelsSmeulders et al, 13 but in conflict with the opposite finding in a study by Ladfors et al 5 Any independent association between neonatal sepsis and parity, as well as with high birth weight and increasing gestational age, is difficult to explain biologically, and confounders not taken into account are possible.…”

“…[1][2][3][4][5][6][7][8][9][10][11][12][13][14] At term birth, a common cutoff to define prolonged rupture of membranes is 18 hours, an interval that has been associated with an increased risk of neonatal group B streptococcal sepsis. 10 This is also a limit after which antibiotic prophylaxis is recommended unless screening for group B streptococci (GBS) has been performed.…”

Clinical chorioamnionitis at term I: microbiology of the amniotic cavity using cultivation and molecular techniques

“…Clinical chorioamnionitis at term is associated with a 2- to 4-fold increase in endometritis [16], wound infection [16], septic pelvic thrombophlebitis [3, 16], pelvic abscess [3, 16], maternal admission to the intensive care unit [3, 17], and postpartum hemorrhage [3, 18]. Neonates born to mothers with clinical chorioamnionitis have a high risk of neonatal mortality [1], short-and-long term complications such as neonatal sepsis [19–21], meconium aspiration syndrome [22, 23], stillbirth [24, 25], and neurodevelopmental disorders including cerebral palsy [26–37]. …”

Cord Blood Levels of Interleukin-6 and Interleukin-8 for the Immediate Diagnosis of Early-Onset Infection in Premature Infants

“…Ascending infections caused by pathogens of the maternal rectovaginal flora and subsequent chorioamnionitis are the main cause of sepsis in premature newborns. On the other hand, chorioamnionitis can lead to premature termination of pregnancy, either because the infection causes intractable contractions, or because birth is induced by the physician because of an increasing risk for mother or fetus [4][5][6][7]. Early-onset sepsis is usually clinically observed within the first 48 h post partum.…”