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Licensed Unlicensed Requires Authentication Published by De Gruyter May 23, 2018

Incidence of early-onset sepsis in infants born to women with clinical chorioamnionitis

  • Tara M. Randis EMAIL logo , Madeline Murguia Rice , Leslie Myatt , Alan T.N. Tita , Kenneth J. Leveno , Uma M. Reddy , Michael W. Varner , John M. Thorp , Brian M. Mercer , Mara J. Dinsmoor , Susan M. Ramin , Marshall W. Carpenter , Philip Samuels , Anthony Sciscione , Jorge E. Tolosa , George Saade , Yoram Sorokin and for the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) Maternal-Fetal Medicine Units (MFMU) Network

Abstract

Objective

To determine the frequency of sepsis and other adverse neonatal outcomes in women with a clinical diagnosis of chorioamnionitis.

Methods

We performed a secondary analysis of a multi-center placebo-controlled trial of vitamins C/E to prevent preeclampsia in low risk nulliparous women. Clinical chorioamnionitis was defined as either the “clinical diagnosis” of chorioamnionitis or antibiotic administration during labor because of an elevated temperature or uterine tenderness in the absence of another cause. Early-onset neonatal sepsis was categorized as “suspected” or “confirmed” based on a clinical diagnosis with negative or positive blood, urine or cerebral spinal fluid cultures, respectively, within 72 h of birth. Adjusted odds ratios (ORs) and 95% confidence intervals (CIs) were estimated by logistic regression.

Results

Data from 9391 mother-infant pairs were analyzed. The frequency of chorioamnionitis was 10.3%. Overall, 6.6% of the neonates were diagnosed with confirmed (0.2%) or suspected (6.4%) early-onset sepsis. Only 0.7% of infants born in the setting of chorioamnionitis had culture-proven early-onset sepsis versus 0.1% if chorioamnionitis was not present. Clinical chorioamnionitis was associated with both suspected [OR 4.01 (3.16–5.08)] and confirmed [OR 4.93 (1.65–14.74)] early-onset neonatal sepsis, a need for resuscitation within the first 30 min after birth [OR 2.10 (1.70–2.61)], respiratory distress [OR 3.14 (2.16–4.56)], 1 min Apgar score of ≤3 [OR 2.69 (2.01–3.60)] and 4–7 [OR 1.71 (1.43–2.04)] and 5 min Apgar score of 4–7 [OR 1.67 (1.17–2.37)] (vs. 8–10).

Conclusion

Clinical chorioamnionitis is common and is associated with neonatal morbidities. However, the vast majority of exposed infants (99.3%) do not have confirmed early-onset sepsis.


Corresponding author: Tara M. Randis, MD, MS, Department of Pediatrics, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA; and Department of Pediatrics and Microbiology, New York University School of Medicine, 317 East 34th St, Suite 902, New York, NY 10016, USA, Tel.: 646-754-1041
a See Appendix for a list of other members of the NICHD MFMU Network.

Acknowledgments

Presented in part at the Pediatric Academic Societies’ 2015 Annual Meeting. The authors thank Richard A. Polin, MD (Columbia University College of Physicians and Surgeons) for contributions to the design of this secondary analysis and review and editing of the manuscript; Sabine Bousleiman, RNC, MSN, and Margaret Cotroneo, RN for protocol development and coordination between clinical research centers; Rebecca Clifton, PhD for protocol/data management; Vinay Bhandaru, MS for statistical analysis; and Gail D. Pearson, MD, ScD, Elizabeth Thom, PhD, James M. Roberts, MD, and Catherine Y. Spong, MD for protocol development and oversight.

  1. Author’s statement

  2. Conflict of interest: The authors have no conflicts of interest relevant to this article to disclose.

  3. Material and methods: Informed consent: Informed consent has been obtained from all individuals included in this study.

  4. Ethical approval: The research related to human subject use has complied with all the relevant national regulations, and institutional policies, and is in accordance with the tenets of the Helsinki Declaration, and has been approved by the authors’ institutional review board or equivalent committee.

  5. Financial disclosure: The authors have no financial relationships relevant to this article to disclose.

  6. Funding source: The project described was supported by grants from the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) [HD34208, HD27869, HD40485, HD40560, HD40544, HD34116, HD40512, HD21410, HD40545, HD40500, HD27915, HD34136, HD27860, HD53118, HD53097, HD27917, and HD36801]; the National Heart, Lung, and Blood Institute; and the National Center for Research Resources [M01 RR00080, UL1 RR024153, UL1 RR024989]. Comments and views of the authors do not necessarily represent the views of the NIH.

  7. Source of the work or study: Combined Antioxidants and Preeclampsia Prediction Studies, Clinical Trial.gov Identifier NCT00135707.

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Supplementary Material

The online version of this article offers supplementary material (https://doi.org/10.1515/jpm-2017-0192).


Received: 2017-06-12
Accepted: 2018-03-06
Published Online: 2018-05-23
Published in Print: 2018-10-25

©2018 Walter de Gruyter GmbH, Berlin/Boston

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