Chorioamnionitis and Neonates; Which Strategy?

Abstract

<jats:p> <jats:bold>Background:</jats:bold> Chorioamnionitis (CAM) is one of the major risk factors for neonatal early-onset sepsis (EOS). Different international guidelines have been developed for diagnosis and care of such neonates. This research aimed to evaluate our neonates and compare them with the guidelines. <jats:bold>Methods:</jats:bold> This prospective cohort study was conducted during five years (March 2012 to March 2017), and comprised of neonates (any gestational age) born to mothers with CAM (any criteria). The neonates’ clinical findings and interventions were collected and analyzed. <jats:bold>Results:</jats:bold> In total, out of 28,988 live born neonates, CAM was found in mothers of 169 neonates (1.7%). Among the studied neonates, 30.8% were born ≤34 week of gestation, 39% had birth weight &lt;2500 g, and 58.6% were asymptomatic. Out of 99 asymptomatic neonates, 47 were observed near mothers and 52 admitted to the neonatal intensive care unit (NICU). The frequency of abnormal tests was 23.07% in asymptomatic vs. 35.7% in symptomatic neonates; three neonates developed culture positive EOS (2.75%) and 68.05% of the neonates received antibiotics. The length of stay was 2.59 ± 1.13 (median = 2.00, IQR = 1.00) days in asymptomatic vs. 15.15 ± 13.67 (median = 7.00, IQR = 15.25) days in symptomatic neonates (P&lt;0.001). <jats:bold>Conclusion:</jats:bold> The use of guidelines increased the length of stay, lab tests, and antibiotics in asymptomatic and neonates with negative blood culture. In addition to the mother-neonate separation, these guidelines may increase nosocomial infection, antibiotic resistance, and costs; therefore, new guidelines are needed to be developed.</jats:p>

Predictor Factors of Continuous Positive Airway Pressure Failure in Preterm Infants with Respiratory Distress

“…Nasal CPAP failure with APGAR score <3 in the first minute was 54.5%, APGAR score 4-7 was 37.5%, and APGAR score 7> was 10.5%. This result was different from the study conducted by Afjeh et al, 10 which showed 1-minute APGAR score was a predictor of CPAP failure in infants with very low birth weight and RDS. In our study, APGAR score was significantly related with CPAP failure based on bivariate analysis, but in multivariate analysis is did not proved to be a significant predictor of nasal CPAP failure.…”

Initial respiratory support outcomes and associated factors among preterm neonates with respiratory distress syndrome admitted at Moi Teaching and Referral hospital Eldoret, Kenya

“…We enrolled 320 neonates, 172(53.8%) were male with a mean (SD) gestation age of 30.9 (2.95) weeks. The mothers mean age was 27 years, ranging (15–43). 70(22.4%) 95%CI:17.95,27.47] had IRS failure and 243(77.6%) had IRS success.…”

“…However, these findings were dissimilar to the study by Afjeh et al, where the noninvasive respiratory initial respiratory support (RA, oxygen via prongs, NCPAP/NIPPV) was successful in 147(41.7%) but failed in 175 (54.3%) neonates. (15). This could be attributed to a difference in study participants of VLBW neonates whereas our study had neonates ranging 575g to 2435g.…”

“…Even with these guidelines recommending CPAP as the primary mode of respiratory support, some studies have shown an increase in CPAP failure rates and poor prognostic outcomes. (12)(13) (14) (15).…”

Suspected clinical chorioamnionitis with peak intrapartum temperature <380C: the prevalence of confirmed chorioamnionitis and short term neonatal outcome

“…This might justify our clinical suspicion of CA even in the absence of a PIT of 38 0 C and more. In a recent prospective cohort study conducted by Sayyed AA et al among neonates exposed to suspected CA, 36% had PIT<37.8 0 C [ 42 ]. We observed that many of the mothers received intrapartum paracetamol if the temperature increased beyond 37.5 0 C, especially if it happened two or more times.…”