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Multicenter Study
. 2016 Jan;137(1):e20152323.
doi: 10.1542/peds.2015-2323. Epub 2015 Dec 30.

Chorioamnionitis and Culture-Confirmed, Early-Onset Neonatal Infections

Jonathan M Wortham  1 , Nellie I Hansen  2 , Stephanie J Schrag  3 , Ellen Hale  4 , Krisa Van Meurs  5 , Pablo J Sánchez  6 , Joseph B Cantey  6 , Roger Faix  7 , Brenda Poindexter  8 , Ronald Goldberg  9 , Matthew Bizzarro  10 , Ivan Frantz  11 , Abhik Das  12 , William E Benitz  5 , Andi L Shane  4 , Rosemary Higgins  13 , Barbara J Stoll  4 ; Eunice Kennedy Shriver NICHD Neonatal Research Network
Collaborators, Affiliations
Multicenter Study

Chorioamnionitis and Culture-Confirmed, Early-Onset Neonatal Infections

Jonathan M Wortham et al. Pediatrics. 2016 Jan.

Abstract

Background: Current guidelines for prevention of neonatal group B streptococcal disease recommend diagnostic evaluations and empirical antibiotic therapy for well-appearing, chorioamnionitis-exposed newborns. Some clinicians question these recommendations, citing the decline in early-onset group B streptococcal disease rates since widespread intrapartum antibiotic prophylaxis implementation and potential antibiotic risks. We aimed to determine whether chorioamnionitis-exposed newborns with culture-confirmed, early-onset infections can be asymptomatic at birth.

Methods: Multicenter, prospective surveillance for early-onset neonatal infections was conducted during 2006-2009. Early-onset infection was defined as isolation of a pathogen from blood or cerebrospinal fluid collected ≤ 72 hours after birth. Maternal chorioamnionitis was defined by clinical diagnosis in the medical record or by histologic diagnosis by placental pathology. Hospital records of newborns with early-onset infections born to mothers with chorioamnionitis were reviewed retrospectively to determine symptom onset.

Results: Early-onset infections were diagnosed in 389 of 396,586 live births, including 232 (60%) chorioamnionitis-exposed newborns. Records for 229 were reviewed; 29 (13%) had no documented symptoms within 6 hours of birth, including 21 (9%) who remained asymptomatic at 72 hours. Intrapartum antibiotic prophylaxis exposure did not differ significantly between asymptomatic and symptomatic infants (76% vs 69%; P = .52). Assuming complete guideline implementation, we estimated that 60 to 1400 newborns would receive diagnostic evaluations and antibiotics for each infected asymptomatic newborn, depending on chorioamnionitis prevalence.

Conclusions: Some infants born to mothers with chorioamnionitis may have no signs of sepsis at birth despite having culture-confirmed infections. Implementation of current clinical guidelines may result in early diagnosis, but large numbers of uninfected asymptomatic infants would be treated.

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Conflict of interest statement

POTENTIAL CONFLICT OF INTEREST: The authors have indicated they have no potential conflicts of interest to disclose.

Figures

FIGURE 1
FIGURE 1
Steps for estimating the number of well-appearing infants born to women with chorioamnionitis potentially treated for each initially asymptomatic infant with culture-confirmed, early-onset infection assuming complete implementation of the Guidelines for Prevention of Perinatal Group B Streptococcal Disease.
FIGURE 2
FIGURE 2
Flow of subject selection from infants with culture-confirmed, early-onset infections identified in the original surveillance study conducted during 2006–2009 at 16 university-based centers of the Neonatal Research Network to inclusion in the present retrospective detailed review of infants with early-onset infections and maternal chorioamnionitis.
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