Clinical Monitoring of Well-Appearing Infants Born to Mothers With Chorioamnionitis

Pediatrics. 2018 Apr;141(4):e20172056. doi: 10.1542/peds.2017-2056.

Abstract

Background: The risk of early-onset sepsis is low in well-appearing late-preterm and term infants even in the setting of chorioamnionitis. The empirical antibiotic strategies for chorioamnionitis-exposed infants that are recommended by national guidelines result in antibiotic exposure for numerous well-appearing, uninfected infants. We aimed to reduce unnecessary antibiotic use in chorioamnionitis-exposed infants through the implementation of a treatment approach that focused on clinical presentation to determine the need for antibiotics.

Methods: Within a quality-improvement framework, a new treatment approach was implemented in March 2015. Well-appearing late-preterm and term infants who were exposed to chorioamnionitis were clinically monitored for at least 24 hours in a level II nursery; those who remained well appearing received no laboratory testing or antibiotics and were transferred to the level I nursery or discharged from the hospital. Newborns who became symptomatic were further evaluated and/or treated with antibiotics. Antibiotic use, laboratory testing, culture results, and clinical outcomes were collected.

Results: Among 277 well-appearing, chorioamnionitis-exposed infants, 32 (11.6%) received antibiotics during the first 15 months of the quality-improvement initiative. No cases of culture result-positive early-onset sepsis occurred. No infant required intubation or inotropic support. Only 48 of 277 (17%) patients had sepsis laboratory testing. The implementation of the new approach was associated with a 55% reduction (95% confidence interval 40%-65%) in antibiotic exposure across all infants ≥34 weeks' gestation born at our hospital.

Conclusions: A management approach using clinical presentation to determine the need for antibiotics in chorioamnionitis-exposed infants was successful in reducing antibiotic exposure and was not associated with any clinically relevant delays in care or adverse outcomes.

MeSH terms

  • Anti-Bacterial Agents / therapeutic use
  • Chorioamnionitis / blood
  • Chorioamnionitis / diagnosis*
  • Chorioamnionitis / drug therapy
  • Female
  • Humans
  • Infant, Newborn
  • Monitoring, Physiologic / methods
  • Monitoring, Physiologic / standards*
  • Nurseries, Hospital / standards*
  • Outcome Assessment, Health Care / methods
  • Outcome Assessment, Health Care / standards
  • Pregnancy
  • Prenatal Exposure Delayed Effects / blood
  • Prenatal Exposure Delayed Effects / diagnosis*
  • Prenatal Exposure Delayed Effects / drug therapy
  • Quality Improvement / standards*

Substances

  • Anti-Bacterial Agents