@article{5643fcda5b8344eb88454067e6661567,
title = "Chorioamnionitis and culture-confirmed, early-onset neonatal infections",
abstract = "Background: Current guidelines for prevention of neonatal group B streptococcal disease recommend diagnostic evaluations and empirical antibiotic therapy for well-appearing, chorioamnionitis-exposed newborns. Some clinicians question these recommendations, citing the decline in early-onset group B streptococcal disease rates since widespread intrapartum antibiotic prophylaxis implementation and potential antibiotic risks. We aimed to determine whether chorioamnionitis-exposed newborns with culture-confirmed, earlyonset infections can be asymptomatic at birth. Methods: Multicenter, prospective surveillance for early-onset neonatal infections was conducted during 2006-2009. Early-onset infection was defined as isolation of a pathogen from blood or cerebrospinal fluid collected ≤72 hours after birth. Maternal chorioamnionitis was defined by clinical diagnosis in the medical record or by histologic diagnosis by placental pathology. Hospital records of newborns with early-onset infections born to mothers with chorioamnionitis were reviewed retrospectively to determine symptom onset. Results: Early-onset infections were diagnosed in 389 of 396 586 live births, including 232 (60%) chorioamnionitis-exposed newborns. Records for 229 were reviewed; 29 (13%) had no documented symptoms within 6 hours of birth, including 21 (9%) who remained asymptomatic at 72 hours. Intrapartum antibiotic prophylaxis exposure did not differ significantly between asymptomatic and symptomatic infants (76% vs 69%; P =.52). Assuming complete guideline implementation, we estimated that 60 to 1400 newborns would receive diagnostic evaluations and antibiotics for each infected asymptomatic newborn, depending on chorioamnionitis prevalence. Conclusions: Some infants born to mothers with chorioamnionitis may have no signs of sepsis at birth despite having culture-confirmed infections. Implementation of current clinical guidelines may result in early diagnosis, but large numbers of uninfected asymptomatic infants would be treated.",
author = "Wortham, {Jonathan M.} and Hansen, {Nellie I.} and Schrag, {Stephanie J.} and Ellen Hale and {Van Meurs}, Krisa and S{\'a}nchez, {Pablo J.} and Cantey, {Joseph B.} and Roger Faix and Brenda Poindexter and Ronald Goldberg and Matthew Bizzarro and Ivan Frantz and Abhik Das and Benitz, {William E.} and Shane, {Andi L.} and Rosemary Higgins and Stoll, {Barbara J.}",
note = "Funding Information: Participating Neonatal Research Network (NRN) sites collected data and transmitted them to RTI International, the data coordinating center (DCC) for the network, which stored, managed, and analyzed the data for this study. On behalf of the NRN, Dr Abhik Das (DCC Principal Investigator) and Ms Nellie I. Hansen (DCC Statistician) had full access to all of the data in the study and, with the NRN Center principal investigators, take responsibility for the integrity of the data and accuracy of the data analysis. The original surveillance study was supported, in part, by PHS grant UL1 RR0025008 from the Clinical and Translational Science Award Program, National Institutes of Health, National Center for Research Resources. The following investigators, in addition to those listed as authors, participated in this study: NRN Steering Committee Chair: Michael S. Caplan, MD: University of Chicago, Pritzker School of Medicine (2006-2011). Abbot R. Laptook, MD, Angellita M. Hensman, MS RNC-NIC BSN, William Oh, MD: Alpert Medical School of Brown University and Women & Infants Hospital of Rhode Island (General Clinical Research Center (GCRC) Grant: U10 HD27904). Michelle C. Walsh, MD MS; Avroy A. Fanaroff, MD, Nancy S. Newman, RN: Case Western Reserve University, Rainbow Babies & Children''s Hospital (GCRC U10 HD21364, M01 RR80). Centers for Disease Control and Prevention (Interagency Agreement 05FED32885-00). Kurt Schibler, MD, Edward F. Donovan, MD, Cathy Grisby, BSN, CCRC, Barbara Alexander, RN, Kate Bridges, MD, Jody Hessling, RN, Holly L. Mincey, RN, BSN: Cincinnati Children''s Hospital Medical Center, University of Cincinnati Medical Center, and Good Samaritan Hospital (U10 HD27853, M01 RR8084). C. Michael Cotten, MD, MHS, Kimberley A. Fisher, PhD, FNP-BC, IBCLC, Kathy J. Auten, MSHS, Katherine A. Foy, RN, Sandra Grimes, RN, BSN: Duke University School of Medicine, University Hospital, and Duke Regional Hospital (GCRC U10 HD40492, UL1 TR1117, M01 RR30). David P. Carlton, MD, Yvonne C. Loggins, RN, BSN: Emory University, Children''s Healthcare of Atlanta, Grady Memorial Hospital, and Emory University Hospital Midtown (U10 HD27851, M01 RR39). Stephanie Wilson Archer, MA: Eunice Kennedy Shriver National Institute of Child Health and Human Development. Leslie Dawn Wilson, BSN, CCRC, Dianne E. Herron, RN, Lucy C. Miller, RN, BSN, CCRC: Indiana University, University Hospital, Methodist Hospital, Riley Hospital for Children at Indiana University Health, and Eskenazi Health (GCRC U10 HD27856, M01 RR750). W. Kenneth Poole, PhD (deceased), Kristin M. Zaterka-Baxter, RN, BSN, CCRP, Margaret Crawford, BS, CCRP, Jeanette O''Donnell Auman, BS, Carolyn M. Petrie Huitema, MS, CCRP: RTI International (GCRC U10 HD36790). David K. Stevenson, MD, M. Bethany Ball, BS, CCRC, Marian M. Adams, MD, Magdy Ismail, MD, MPH, Andrew W. Palmquist, RN, BSN, Melinda S. Proud, RCP: Stanford University, Dominican Hospital, El Camino Hospital, and Lucile Packard Children''s Hospital (GCRC U10 HD27880, M01 RR70). Brenda L. MacKinnon, RNC, Ellen Nylen, RN, BSN: Tufts Medical Center, Floating Hospital for Children (GCRC U10 HD53119, M01 RR54). Waldemar A. Carlo, MD, Namasivayam Ambalavanan, MD, Monica V. Collins, RN, BSN, MAEd, Shirley S. Cosby, RN, BSN: University of Alabama at Birmingham Health System and Children''s Hospital of Alabama (GCRC U10 HD34216, M01 RR32). Edward F. Bell, MD, John A. Widness, MD, Karen J. Johnson, RN, BSN: University of Iowa (GCRC U10 HD53109, M01 RR59). Kristi L. Watterberg, MD, Conra Backstrom Lacy, RN, Rebecca A. Montman, BSN, RNC: University of New Mexico Health Sciences Center (U10 HD53089, M01 RR997). Charles R. Rosenfeld, MD, Luc P. Brion, MD, Walid A. Salhab, MD, Alicia Guzman, Gaynelle Hensley, RN, Melissa H. Leps, RN, Nancy A. Miller, RN, Diane M. Vasil, RNC-NIC: University of Texas Southwestern Medical Center at Dallas, Parkland Health & Hospital System, and Children''s Medical Center Dallas (GCRC U10 HD40689, M01 RR633). Kathleen A. Kennedy, MD, MPH, Jon E. Tyson, MD, MPH, Julie Arldt-McAlister, RN, BSN, Georgia E. McDavid, RN, Sharon L. Wright, MT (ASCP): University of Texas Health Science Center at Houston Medical School and Children''s Memorial Hermann Hospital (GCRC U10 HD21373). Bradley A. Yoder, MD, Karen A. Osborne, RN, BSN, CCRC, Karie Bird, RN, BSN, Jennifer J. Jensen, RN, BSN, Cynthia Spencer, RNC, Kimberlee Weaver-Lewis, RN, BSN: University of Utah Medical Center, Intermountain Medical Center, LDS Hospital, and Primary Children''s Medical Center (GCRC U10 HD53124, M01 RR64). Seetha Shankaran, MD, Rebecca Bara, RN, BSN, Mary E. Johnson, RN, BSN, Elizabeth Billian, RN, MBA: Wayne State University, University of Michigan, Hutzel Women''s Hospital, and Children''s Hospital of Michigan (U10 HD21385). Richard A. Ehrenkranz, MD, Harris C. Jacobs, MD, Monica Konstantino, RN, BSN, Patricia Cervone, RN, JoAnn Poulsen, RN, Janet Taft, RN, BSN: Yale University, Yale-New Haven Children''s Hospital, and Bridgeport Hospital (U10 HD27871, M01 RR125, UL1 TR142). We thank our medical and nursing colleagues and the infants and their parents who agreed to take part in this study. This study was supported by funding from the Eunice Kennedy Shriver National Institute of Child Health and Human Development and the Centers for Disease Control and Prevention. Funded by the National Institutes of Health (NIH). Publisher Copyright: {\textcopyright} 2016 by the American Academy of Pediatrics.",
year = "2016",
month = jan,
doi = "10.1542/peds.2015-2323",
language = "English (US)",
volume = "137",
journal = "Pediatrics",
issn = "0031-4005",
publisher = "American Academy of Pediatrics",
number = "1",
}