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A Murine Model of Fetal Exposure to Maternal Inflammation to Study the Effects of Acute Chorioamnionitis on Newborn Intestinal Development
Published on: June 24, 2020
Chorioamnionitis: epidemiology of newborn management and outcome United States 2008
1Department of Pediatrics, University of Texas Medical Branch, Galveston, TX, USA.
Insights
Chorioamnionitis exposure increases neonatal mortality risk. Antibiotic treatment guidelines for exposed newborns are not consistently followed, impacting infant survival rates.
Area of Science:
- Neonatal Health
- Perinatal Epidemiology
- Infectious Disease in Newborns
Background:
- Current guidelines recommend antibiotics for all term newborns exposed to chorioamnionitis.
- The prevalence of chorioamnionitis and its impact on neonatal outcomes require further investigation.
Purpose of the Study:
- To determine the prevalence of chorioamnionitis exposure in term infants.
- To analyze the association between chorioamnionitis, intrapartum antibiotics, NICU admission, and neonatal mortality.
Main Methods:
- Utilized 2008 US birth and death certificate data for 2,281,386 births.
- Analyzed maternal, labor, delivery, and infant factors for associations with chorioamnionitis and neonatal outcomes.
Main Results:
- Chorioamnionitis prevalence was 9.7 per 1000 live births.
- Neonatal mortality rate was higher in exposed infants (1.40/1000 LB) vs. unexposed (0.81/1000 LB), OR=1.72.
- Antibiotic treatment for exposed infants did not significantly alter neonatal death risk (OR=0.69).
Conclusions:
- Chorioamnionitis exposure is linked to increased neonatal mortality risk.
- Adherence to antibiotic treatment guidelines for exposed neonates is low.
Objective:
Current American Academy of Pediatric recommendations call for the empirical use of antibiotics for all well-appearing term newborn infants born to women given a diagnosis of chorioamnionitis. The objective of this analysis was to determine among term infants (37-42 weeks gestation) the prevalence of exposure to clinical chorioamnionitis, intrapartum antibiotics, infant antibiotic use and neonatal intensive care unit (NICU) admission and the relationship of these risk factors to neonatal mortality.
Study Design:
United States-linked infant birth and death certificate files for the year 2008 were used. Maternal demographic variables, labor and delivery risk factors and infant characteristics were analyzed for associations with a reported diagnosis of chorioamnionitis and neonatal death, NICU admission and antibiotic usage.
Result:
There were 2,281,386 births available with information on the diagnosis of chorioamnionitis. The prevalence of chorioamnionitis in this population was 9.7 per 1000 live births (LB) and the neonatal mortality rate for exposed infants was 1.40/1000 LB vs 0.81/1000 LB for infants without chorioamnionitis, odds ratio (OR)=1.72, 95% confidence interval 1.20-2.45. The OR for neonatal death for infants with chorioamnionitis exposure who received antibiotics vs those who did not was 0.69 (95% confidence interval=0.21-2.26).
Conclusion:
Exposure to chorioamnionitis is associated with an increased risk of neonatal mortality. Guidelines for treatment of infants exposed to chorioamnionitis with antibiotics are followed in only a small proportion of such cases.
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