Role of Guidelines on Length of Therapy in Chorioamnionitis and Neonatal Sepsis

Kiser, Courtney; Nawab, Ursula; McKenna, Kristin; Aghai, Zubair H.

doi:10.1542/peds.2013-2927

Cited by 100 publications

(96 citation statements)

References 28 publications

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“…It is also proved that funisitis / chorioamnionitis is associated with a higher risk of neonatal sepsis (21)(22). However, some researchers claim that the histological diagnosis of chorioamnionitis is not important in the prediction of newborn's further quality of life, especially if these newborns get adequate treatment and care (23)(24). Our study has shown the association between the increased CRP levels in mother's blood serum and histologically confirmed intrauterine infection, as well as congenital infection.…”

Section: Discussionmentioning

confidence: 50%

Preterm premature rupture of membranes at 32–34 weeks of gestation: duration of membrane rupture period and maternal blood indicators relation with congenital infection

Daunoravičienė¹,

Musteikytė²,

Ramašauskaitė³

2015

AML

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Background. The study investigates the influence of the length of membrane rupture period among pregnant women with preterm premature rupture of membranes (PPROM) between the 32nd and 34th weeks of gestation on the development of chorioamnionitis and the congenital infection of a newborn. It seeks to ascertain the values of indicators in mother's blood that enable to predict chorioamnionitis and funisitis for mothers, and congenital infection for newborns.Materials and methods. A retrospective study of case records of women with PPROM at 32 (32 w. + 0 d)-34 (33 w. + 6 d) weeks of gestation and their newborns was performed. Two comparative groups were made: 1) of women who had funisitis and / or chorioamnionitis with or without deciduitis and 2) of women having no proved inflammation (according to the results of histological examination of placentae). Analogically, comparative groups were made of their newborns: those who had diagnosis of congenital infection and those who had no infection. The duration of membrane rupture period and the blood markers were investigated in all the groups.Results. The study included 135 women. Duration of the membrane rupture period lasted 85.17 ± 84.72 hrs in the group of women who had histological inflammation, and 40.06 ± 56.57 hrs in the group with no inflammation, P = 0.01, AUC = 0.735; the critical membrane rupture period value for developing intrauterine infection by the Youden index was 43.7 hrs. The corresponding maternal CRP values (mg/l) were 25.85 ± 40.27 vs. 5.23 ± 7.88 (P = 0.01, AUC = 0.6), the Youden index 4.6 mg/l. For the mothers of the newborns diagnosed with infection, the duration of the membrane rupture period was 55.95 ± 65.04 hrs, for the mothers of the newborns without congenital infection it was 40.25 ± 73.71 hours. Respectively, CRP values for the mothers of newborns averaged 12.25 ± 22.14 mg/l vs. 4.8 ± 4.82 mg/l (P = 0.005).Conclusions. Longer membrane rupture period and higher maternal CRP are correlated with inflammatory changes in the placenta and umbilical cord, thus they can be used as the prognostic indicators of intrauterine infection. When the duration of the membrane rupture period lasts ≥44 hrs, the risk of chorioamnionitis and funisitis increases five times; when the maternal serum CRP is higher than 5 mg/l, funisitis / chorioamnionitis is twice more frequent than at lower than 5 mg/l CRP values.

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Section: Discussionmentioning

confidence: 50%

Preterm premature rupture of membranes at 32–34 weeks of gestation: duration of membrane rupture period and maternal blood indicators relation with congenital infection

Daunoravičienė¹,

Musteikytė²,

Ramašauskaitė³

2015

AML

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“…4–6 In addition, many newborns are treated with antimicrobial agents for prolonged periods despite negative blood culture results. 5,6 Since administration of antimicrobial agents oftentimes is accompanied by admission to a neonatal intensive care unit (NICU), a large number of newborns are additionally exposed to the NICU environment where there is increased risk of acquiring infections with multi-drug resistant bacteria. Infants in NICUs are also separated from their families, which may have consequences for mother-infant attachment and successful breastfeeding.…”

Section: Review Of the Current Understanding Of Chorioamnionitismentioning

confidence: 99%

Evaluation and Management of Women and Newborns With a Maternal Diagnosis of Chorioamnionitis

Higgins

Saade

Polin

et al. 2016

Obstetrics &Amp; Gynecology

490

345

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In January 2015, the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) invited an expert panel to a workshop to address numerous knowledge gaps, and to provide evidence-based guidelines for the diagnosis and management of pregnant women with what had been commonly called chorioamnionitis and the infants born to these women. The panel noted that the term chorioamnionitis has been used to label a heterogeneous array of conditions characterized by infection and inflammation or both, with a consequent great variation in clinical practice for mothers and their newborns. Therefore, the panel proposed to replace the term chorioamnionitis with a more general, descriptive term, “intrauterine inflammation or infection or both,” abbreviated as “Triple I.” The panel proposed a classification for Triple I and recommended approaches to evaluation and management of pregnant women and their newborns with a diagnosis of Triple I. It is particularly important to recognize that an isolated maternal fever is not synonymous with chorioamnionitis. A research agenda was proposed to further refine the definition and management of this complex group of conditions. This article provides a summary of the workshop presentations and discussions.

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“…Comparable data for EOS of all causes also reflect a reduction in attack rate, from 2.0 – 2.5 in the late 1980s and 1990s 23–25 to 0.8 – 1.0 per 1000 live births since 2005 26, 27 . Among infants ≥ 34 28 or ≥ 35 29, 30 weeks gestation or with birth weights > 2500 g 26 , recent EOS rates are only 0.5 – 0.8 per 1000 live births. These much lower attack rates reflect a landscape that is fundamentally different from that extant when consensus guidelines for neonatal sepsis management were being developed 20 years ago.…”

Section: The Evolution Of Neonatal Sepsis Risk Assessmentmentioning

confidence: 99%

Reappraisal of Guidelines for Management of Neonates with Suspected Early-Onset Sepsis

Benitz

Wynn

Polin

2015

The Journal of Pediatrics

140

129

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Since 1992, professional societies or public health agencies in the United States1–12 and elsewhere13–17 have issued several generations of recommendations for prevention or management of early-onset neonatal sepsis (EOS). Despite those efforts, recommendations remain inconsistent, clarifications are necessary18, local adaptations are common19, and compliance rates are low20. We postulate that lack of consensus, especially regarding postnatal management of the neonate, is largely a result of two sets of factors. First, obstetrical prevention strategies have substantially reduced incidence of EOS, potentially changing the utility of predictive strategies based on risk factors. Second, recent data better delineate relationships among risk factors, clinical signs, and EOS, suggesting that risk predictors may have different utilities in different groups. The purpose of this commentary is to explore these questions and to suggest new approaches to management of newborns who may be at risk for EOS.

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Role of Guidelines on Length of Therapy in Chorioamnionitis and Neonatal Sepsis

Cited by 100 publications

References 28 publications

Preterm premature rupture of membranes at 32–34 weeks of gestation: duration of membrane rupture period and maternal blood indicators relation with congenital infection

Preterm premature rupture of membranes at 32–34 weeks of gestation: duration of membrane rupture period and maternal blood indicators relation with congenital infection

Evaluation and Management of Women and Newborns With a Maternal Diagnosis of Chorioamnionitis

Reappraisal of Guidelines for Management of Neonates with Suspected Early-Onset Sepsis

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