Neonatal sepsis in pregnant at term with clinical chorioamnionitis, utility of sepsis score
Article Sidebar
Main Article Content
Abstract
Introduction: chorioamnionitis occurs in 3 to 10 % of full-term pregnancies, and newborns are at risk of developing early sepsis.
Objectives: to determine the prevalence of neonatal sepsis in children of term pregnant women with chorioamnionitis; describe the clinical characteristics of mothers and newborns; and evaluate the utility of the sepsis scale (Rodwell scale and PCR) for diagnosis.
Methodology: descriptive study, of term newborns, product of mothers with clinical chorioamnionitis, born and admitted to the Servicio de Neonatología del Hospital Nacional from January 2013 to June 2016. Stillbirths, carriers of STORCH infections, and they had no blood culture.
Results: 71 term infants met inclusion criteria. The maternal population was made up of adolescents and young adults in 98,5 %, nulliparous and prim parous in 94 %, membrane rupture was >18 hours in 34 (47,8 %) and the birth was performed by caesarean section in 24 (35, 2 %). The reasons for cesarean section were stationary dilation and acute fetal distress in 17 (69,8 %). Neonatal sepsis developed 11 (15,4 %), 3 were confirmed with a positive blood culture, 10 symptoms and 7 depression at birth. Neither died.
The first sepsis scale performed at 3,8 ± 1,8 hours of life, and the second at a median of 45,5 hours, had a positive predictive value of 50 % and 60 %. The negative predictive value was 85 and 87 % respectively.
Conclusion: neonatal sepsis presented in 15,4 %. Almost all were symptomatic and depressed at birth. The sepsis scale was not useful to confirm the diagnosis, but to rule it out.
Article Details
This work is licensed under a Creative Commons Attribution 4.0 International License.
References
Chung Chih P, Jui Hsing Ch, Hslang Yu L, Po Jen Ch, Bai Harng S. Intrauterine inflammation, infection, or both (triple I): A New Concept for Chorioamnionitis. Pediatr and Neonatol. 2018;59(3): 231-237.
Braun D, Bromberger P, Ho NJ, Getahun D. Low rate of perinatal sepsis in term infants of mothers with chorioamnionitis. Am J Perinatol. 2016;33(2):143–150.
Verani JR, McGee L, Schrag SJ; Division of bacterial diseases, national center for immunization and respiratory diseases, centers for disease control and prevention. Prevention of perinatal group B streptococcal disease–revised guidelines from CDC, 2010. MMWR Recomm Rep. 2010;59(RR10):1–36.
Stoll BJ, Hansen NI, Sánchez PJ, Faix RG, Poindexter BB, Van Meurs KP, et al. Early onset neonatal sepsis: the burden of Group B Streptococcal and E. coli disease continues. Pediatr. 2011;127(5):817–826.
Azad MB, Konya T, Persaud RR, Guttman DS, Chari RS, Field CJ, et al. Impact of maternal intrapartum antibiotics, method of birth and breastfeeding on gut microbiota during the first year of life: a prospective cohort study. BJOG. 2016;123(6):983–993
Bridges M, Pesek E, McRae M, Chabra S. Use of an early onset-sepsis calculator to decrease unnecessary nicu admissions and increase exclusive breastfeeding. J Obstet Gynecol Neonatal Nurs. 2019;48(3):372-382. Disponible en: http://jognn.org/article/S0884-2175.
Mukhopadhyay S, Lieberman ES, Puopolo KM, Riley LE, Johnson LC. Effect of early-onset sepsis evaluations on in-hospital breastfeeding practices among asymptomatic term neonates. Hosp Pediatr. 2015;5(4):203–210.
Polin RA, Committee on fetus and newborn. Management of neonates with suspected or proven early-onset bacterial sepsis. Pediatr. 2012; 129(5): 1006–1015.
Rodwell RL, Leslie AL, Tudehope DI. Early Diagnosis of Neonatal Sepsis using a Hematologic Scoring System. J. Pediatr. 1988; 112(5): 761-7.
Higgins RD, Saade G, Polin RA, Grobman WA, Buhimschi IA. Evaluation and management of women and newborns with a maternal diagnosis of chorioamnionitis: summary of a workshop. Obstet Gynecol. 2016; 127(3):426-436.
Newton ER. Chorioamnionitis and intraamniotic infection. Clin Obstet Gynecol. 1993; 36(4): 795–808.
Galán Henríquez GM, García Muñóz FR. Chorioamnionitis and neonatal morbidity: current perspectives. Review. Research and Reports in Neonatology. 2017;7:41-52. Disponible en: http://doi.org/10.2147/RRN.S128751
Fowler Josephine R, Simon Leslie V. Chorioamnionitis. Last Update: October 2019. Stat Pearls (Internet). Disponible en: http://www.ncbi.nlm.nih.gov/books/NBK532251.
Malloy MH. Chorioamnionitits: epidemiology of newborn management and outcome United States 2008. Journal of Perinatology 2014; (34):611-615. Disponible en: http://nature.com/articles/jp201481.
Ferrer Montoya R, Robles Iglesias A, Pérez Dajaruch MÁ, Crespo Bello E, González Vázquez G. Corioamnionitis clínica e histológica. Revisión bibliográfica. Mul Med 2014; 18 (1). Disponible en:
https://www.medigraphic.com/cgibin/new/resumenI.cgi?IDARTICULO=53996
Alan TN, Andrews WW. Diagnosis and management of clinical chorioamnionitis. Clin Perinatol 2010; 37(2):339-354.
Newton ER, Piper J, Peairs W. Bacterial vaginosis and intraamniotic infection. Am J. Obstet Gynecol. 1997; 176(3): 672-7.
Bizzarro MJ, Shabanova V, Baltimore RS, Dembry LM, Ehrenkranz RA, Gallagher PG. Neonatal sepsis 3004-2013: the rise and fall of coagulase-negative staphylocococci. J. of Pediatrics. 2015;166(5):1193-1199. doi: 10.1016/j.jpeds.2015.02.009
Pérez RO, Lona JC, Quiles M, Verdugo MA, Ascencio EP, Benítez EA. Sepsis neonatal temprana, incidencia y factores de riesgo asociados en un hospital público del occidente de México. Rev Chilena Infectol 2015; 32 (4): 387-392.
Wortham Jonathan M, Hansen Nellie I, Schrag Stephanie J, Hale Ellen RN, Meurs Krisa V, et al. Chorioamnionitis and Culture- Confirmed, Early-Onset Neonatal Infections. Pediatrics 2016; 137 (1): e 20152323.
Seaward PG, Hannah ME, Myhr TL. International multicentre term prelabor rupture of membranes study: evaluation of predictors of clinical chorioamnionitis and postpartum fever in patients with pre- labor rupture of membranes at term. Am J Obstet Gynecol 1997; 177: 1024–1029.
Galinsky R, Polglase GR, Hooper SB, Black J, Mos TJ. The Consequences of chorioamnionitis: preterm birth and effects on development. Review Article. Journal of Pregnancy 2013;2013(Article ID 412831):11. Disponible en: http://dx.doi.org/10.1155/2013/412831
Blume HK, Li CI, Loch CM, Koepsell TD. Intrapartum fever and chorioamnionitis as risks for encephalopathy in term newborns: a case–control study. Developmental Medicine & Child Neurology 2008;50: 19–24.
Braun D, Bromberger P, Ho NJ, Getahun D. Low rate of perinatal sepsis in term infants of mothers with chorioamnionitis. Am J Perinatol. 2016; 33(02): 143-150E
Randis TM, Murguia RM, Sorokin Y. Incidence of early-onset sepsis in infants born to women with clinical chorioamnionitis. J Perinat Med. 2018, 46:926-33.
Craig VT, Yates A, Zite N, Smith C, Chernicky L, Howard B. Incidence of fever in labor and risk of neonatal sepsis. Am Journal Obstet and Gynecol 2017;216(6):596.e1-596.e5. Disponible en: https://www.ajog.org/article/S0002-9378(17)30291-0/fulltext
Mukhopadhyay S, Puopolo KM. Risk assesment in neonatal early-onset sepsis. semin perinatol. 2012; 36(6): 408-415. doi:10.1053/j.semperi 2012.06.002
Gilstrap IC, Leveno KJ, Burris JS, Mashburn M, Rosenfeld CR. Intrapartun treatment of acute chorioamnionitis: impact on neonatal sepsis. Am J. Obstet Gynecol 1988 Sep; 159(3): 579-83.
Jan Amanda I, Ramanathan R, Cayabyab RC. Chorioamnionitis and Management of Asymptomatic Infants ≥35 Weeks Without Empiric Antibiotics. Pediatr. 2017; 140 (1): e20162744.
Pendo PM, Kibusi SM, Mkhoi LM. Predictors of early onset neonatal sepsis among neonates in dodoma, tanzania: a case control study. journal of tropical pediatrics. 2019. Disponible https://doi.org/10.1093/tropej/fmz062
Seung ML, Romero R, Yang HJ, Oh HJ. The frequency and risk factors of funisitis and histologic chorioamnionitis in pregnant women at term who delivered after spontaneus onset of labor. J. Matern Fetal Neonatal Med. 2011; 24(1):37-42.
Escobar GJ, DK Li, Armstrong MA, Gardner MN, Folk BF, Verdi JE, et al. Neonatal sepsis workups in infants >/=2000 grams at birth: a population-based study. Pediat. 2000; 106:256-63.
Kissinger PP, Kardana IM, Putu Nilawati GA. Diagnosis accuracy of Hematological scoring sistem in early identification of neonatal sepsis. Balí Med J.2016; 5(3): 139-144.
Berardi A, Buf Chiarafagni AM, Rossi C, Vaccina E, Cattelani K, Gambini L. Serial physical examination, a simple and reliable tool for managing neonates at risk for early-onset sepsis. World J. Clin Pediatr. 2016; 5(4): 358-364.
Neha SJ, Arun C, Allan JM, Aby JIO. Clinical monitoring of well- appearing infants born to mothers with chorioamnionitis. Pediatrics. 2018;141(4):e20172056. Disponible en: www.aapublications.org/news