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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
Not all newborns born to mothers with clinical chorioamnionitis need to be treated
Calanit Hershkovich-Shporen1, Neli Ujirauli2, Shachar Oren2
1Department of Neonatology, Kaplan Medical Center, Hebrew University of Jerusalem, Rehovot, Israel.
Insights
Asymptomatic newborns born to mothers with clinical chorioamnionitis do not require automatic antibiotic treatment. This study found that treating all such newborns is less effective than targeted approaches for preventing early onset sepsis (EOS).
Area of Science:
- Neonatal Medicine
- Infectious Disease Prevention
- Public Health Policy
Background:
- Current guidelines recommend antibiotic treatment for newborns with suspected early onset sepsis (EOS) or born to mothers with clinical chorioamnionitis.
- A protocol change in 2015 aimed to align with these recommendations.
- This study evaluates the safety and necessity of treating all newborns exposed to clinical chorioamnionitis.
Purpose of the Study:
- To prospectively assess the safety of the revised protocol for managing newborns at risk of EOS.
- To evaluate the necessity of routine antibiotic treatment for all newborns born to mothers with clinical chorioamnionitis.
- To retrospectively assess the performance of the EOS risk calculator in identifying high-risk neonates.
Main Methods:
- Prospective study from May 2015 to April 2016 at Kaplan Medical Center.
- Inclusion criteria: gestational age ≥35 weeks, newborns treated with antibiotics, or born to mothers with EOS risk factors or clinical chorioamnionitis, or who received intrapartum antibiotic prophylaxis.
- Evaluation of EOS incidence, treatment rates, and comparison with EOS risk calculator predictions.
Main Results:
- Out of 7058 newborns, 1341 met inclusion criteria; 6 (0.85/1000 live births) had EOS.
- Symptomatic newborns had a significantly higher risk of EOS (RR 10.9).
- Treating all newborns for maternal chorioamnionitis resulted in 201 (15%) treated, whereas the calculator would have treated 111 (8%); a significant difference (p<.001).
Conclusions:
- Routine antibiotic treatment for asymptomatic newborns of mothers with clinical chorioamnionitis is not automatically warranted.
- The EOS risk calculator may help reduce unnecessary antibiotic exposure.
- Clinical presentation and maternal risk factors remain critical in neonatal sepsis management decisions.
Purpose:
The 2010 recommendations of the Centers for Disease Control and Prevention (CDC) for prevention of perinatal group B Streptococcal Disease (GBS) is that symptomatic newborns suspect for early onset sepsis (EOS), or newborns born to mothers with clinical chorioamnionitis should receive antibiotic treatment. Our protocol was changed accordingly during 2015. We prospectively assessed the safety of the protocol and evaluated the need to treat all newborns born to mothers with clinical chorioamnionitis and retrospectively evaluated the performance of the EOS risk calculator.
Methods:
The study period was from May 2015 to April 2016 at the Kaplan Medical Center (KMC). Inclusion criteria were: gestational age of 35 weeks and above, newborns that were treated with antibiotic, newborn born to mothers with risk factors for EOS or with maternal clinical chorioamnionitis, or to mothers that were given intra-partum antibiotic prophylaxis (IAP).
Results:
In the study period, 7058 newborns were born, 1341 (19%) neonates were included according to the inclusion criteria. Six newborns had EOS (0.85 per 1000 live born). 123/1341 (9%) of the neonates were symptomatic of whom six (4.9%) had proven EOS with RR 10.9 (CI 3.5-33.39, p < .0001), NNT was 22.6. Of them, 89/1341 (6.6%) were treated for maternal clinical chorioamnionitis, two (2.25%) had proven EOS, but they were also symptomatic. The RR was 5.03 (CI 1.03-24.6 p = .045) and the NNT was 55.5. Symptomatic newborns were at an increased risk of 2.2 to have EOS compared with newborns with maternal clinical chorioamnionitis. During the study period, 201 (15%) newborns received antibiotic treatment, while if we had only used the calculator, 111 (8%) newborns would have been treated (p<.001). Only one (out of three with maternal risk factors) newborn was symptomatic during the first hour of life. Three of the mothers whose newborn developed EOS, had no risk factors so there was no need for the calculator. The calculated EOS risk at birth for the other three ranged from 0.37 to 0.67.
Conclusions:
We suggest that asymptomatic newborns born to mothers with clinical chorioamnionitis should not receive antibiotic treatment automatically.
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