Management of newborns born to mothers with chorioamnionitis: is it time for a kinder, gentler approach?

Acad Pediatr. May-Jun 2015;15(3):340-4. doi: 10.1016/j.acap.2014.11.007.

Abstract

Objective: Current recommendations are that newborns of mothers with chorioamnionitis have a complete blood count, blood culture, and antibiotic therapy. We hypothesized that utilizing the early-onset sepsis (EOS) risk calculator and a clinical symptom assessment could safely reduce the number of newborns subjected to laboratory testing and antibiotics.

Methods: We reviewed 698 well-appearing newborns of estimated gestational age of ≥34 weeks born to mothers with chorioamnionitis.

Results: Sixty-five percent of newborns were managed according to the guidelines; 1 (0.14%) had culture-positive EOS. A strategy based on the use of the EOS calculator and clinical appearance of the newborn would have reduced the proportion having laboratory tests and antibiotics to 12% and would not have missed any cases of EOS.

Conclusions: The EOS risk in well-appearing newborns of mothers with chorioamnionitis is low. Applying a strategy based on readily obtainable measures rather than the obstetrical diagnosis of chorioamnionitis would result in a substantial reduction of newborns undergoing laboratory tests and being exposed to antibiotics. Further prospective trials evaluating the safety of this approach are warranted.

Keywords: chorioamnionitis; early-onset sepsis; newborns.

MeSH terms

  • Anti-Bacterial Agents / therapeutic use*
  • Blood Cell Count
  • Chorioamnionitis / epidemiology*
  • Female
  • Guideline Adherence
  • Humans
  • Infant, Newborn
  • Microbiological Techniques
  • Practice Guidelines as Topic*
  • Pregnancy
  • Risk Assessment
  • Sepsis / diagnosis
  • Sepsis / epidemiology
  • Sepsis / prevention & control*

Substances

  • Anti-Bacterial Agents