Comparison Between Two Treatment Strategies of Term Neonates Exposed to Maternal Chorioamnionitis

Author Type(s)

Resident/Fellow

Document Type

Abstract

Publication Date

2022

DOI

10.1016/j.ajog.2021.11.768

Journal Title

American Journal of Obstetrics and Gynecology

Department

Obstetrics and Gynecology

Abstract

Objective: Maternal chorioamnionitis (MC) is an acute inflammation or infection of the membranes and chorion of the placenta and is proposed to be a major cause of early neonatal sepsis. Traditionally, all neonates exposed to MC were treated with antibiotics. However, recent evidence showed that some neonates could be managed expectantly. The purpose of this study was to evaluate ACOG’s algorithm on the management of newborns exposed to MC and its comparison with Kaiser’s newborn sepsis calculator. Study Design: A retrospective chart review was performed on neonates ≥37 weeks born to mothers with MC during 2018-2020 at Metropolitan Hospital in New York City. The neonates were evaluated using the two different strategies and were analyzed using t-test, chi-square test and ANOVA. Results: During the study period, 101 infants were exposed to MC and all were given antibiotics per hospital protocol. When the infants were assessed using the Kaiser Calculator, only 16/101 (15.84%) infants would have received treatment. When ACOG’s algorithm was applied to the same cohort 71/101 (70.30%) infants would have received treatment. The two calculators agreed in their assessment for treatment versus observation in 44/101 (43.56%) infants whereas they disagreed on management in 57/101 (56.44%) infants. ACOG recommendation for treatment was associated with chorioamnionitis seen on placental pathology (94.37% vs. 75.00% for Kaiser, p-0.015). Kaiser treated infants with lower 1-minute (6.63 vs 8.21, p-0.006) and 5-minute (8.00 vs. 8.69, p-0.019) Apgar scores when compared to ACOG. Additionally, supplemental oxygen exposure was associated with more infants being treat when using Kaiser compared to ACOG algorithms (62.50% vs. 21.13%, p < 0.001). Conclusion: Both Kaiser Calculator and ACOG Algorithm expose fewer infants to antibiotics than traditional strategies; however, they differ widely on the number of infants that would require antibiotics. Ventilation assistance and lower Apgar scores were associated with higher probability of antibiotic administration.

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