Frozen Section of Placental Membranes and Umbilical Cord: A Valid Diagnostic Tool for Early-Onset Neonatal Sepsis Management

Abstract

Early-onset neonatal sepsis (EONS), a serious infection in newborns within 3 days, is challenging to diagnose. The current methods often lack accuracy, leading to unnecessary antibiotics or delayed treatment. This study investigates the role of the frozen section examination of placental membranes and umbilical cord (FSMU) to improve EONS diagnosis in the daily lab practice. This retrospective study reviewed data from 59 neonates with EONS risk factors who underwent FSMU according to our institutional protocol. Concordance between the FSMU and the Final Pathological Report (FPR) was assessed. The FSMU demonstrated a high concordance (Kappa = 0.88) for funisitis diagnosis, with excellent accuracy (98.3%). A moderate concordance was observed for chorioamnionitis stage and grade. The FSMU shows promise as a rapid and accurate tool for diagnosing EONS, particularly for funisitis. This study suggests that the FSMU could be a valuable tool for EONS diagnosis, enabling a more judicious antibiotic use and potentially improving outcomes for newborns.

Keywords: chorioamnionitis; frozen section examination; funisitis; neonatal sepsis; placenta.

Figure 1

(FSMU; original magnification 200×): (a,b): funisitis; yellow arrows show neutrophilic granulocyte infiltrates in the wall of the umbilical vein ((a): H&E; (b): toluidine blue); (c,d): chorioamnionitis stage 2 grade 2; yellow arrows show neutrophilic granulocyte infiltrates in the chorion of the membranes and minimally in the sub- amniotic connective tissue ((c): H&E; (d): toluidine blue).

Figure 2

(FPR on FFPE tissue; hematoxylin/eosin; original magnification 200×): (A): severe chorioamnionitis G2 stage 2; widespread neutrophilic granulocyte infiltrates in the chorion with extension into the sub-amniotic connective tissue (B): severe funisitis; numerous neutrophilic granulocytes in the wall of the umbilical vein.