Clinical dilemma of positive histologic chorioamnionitis in term newborn.

Alain Cuna,Maria Lyn Quintos-Alagheband,Shahidul Islam,Nazeeh Hanna,Bianca Fornier,Laleh Hakima,Barry Weinberger,Yun-An Tseng,Poonam Khullar

doi:10.3389/fped.2014.00027

Abstract

Background: Although histologic chorioamnionitis (HCA) is known to be associated with poor outcomes in preterm infants, its clinical significance among term infants is not clearly known.Objectives: To investigate the utility of HCA in determining early onset clinical sepsis (EOCS) among term newborns.Methods: The incidence of HCA and EOCS in term infants born during 2008–2009 was evaluated in a single center retrospective study (n = 3417). The predictive value of HCA for determining EOCS in term infants admitted to the neonatal intensive care unit (NICU) for suspected sepsis (n = 388) was quantified. Outcome of otherwise healthy term infants in the nursery with HCA was also investigated.Results: Overall, 11% of term infants with HCA also had EOCS. HCA was associated with increased risk for EOCS (OR 2.6, 95% confidence interval 1.6–4.2, P < 0.001) among term infants admitted to the NICU for suspected sepsis. No cases of EOCS were found among otherwise well-appearing infants in the nursery with HCA. Multiple logistic regression analysis indicated that addition of HCA does not increase the power of a model combining C-reactive protein (CRP) and immature to total neutrophil ratio in determining EOCS.Conclusion: Although HCA in term infants is associated with EOCS, it did not improve the ability of CRP and immature to total neutrophil ratio to predict EOCS. Routine placental examination may not contribute to the diagnosis of EOCS in term infants.

Highlights

Despite advances in obstetrical management including intrapartum antibiotic therapy, early onset clinical sepsis (EOCS) continues to be an important cause of neonatal morbidity and mortality [1]
Histologic chorioamnionitis (HCA) was associated with increased risk for EOCS among term infants admitted to the neonatal intensive care unit (NICU) for suspected sepsis
Multiple logistic regression analysis indicated that addition of HCA does not increase the power of a model combining C-reactive protein (CRP) and immature to total neutrophil ratio in determining EOCS

Summary

Introduction

Despite advances in obstetrical management including intrapartum antibiotic therapy, early onset clinical sepsis (EOCS) continues to be an important cause of neonatal morbidity and mortality [1]. Histologic chorioamnionitis (HCA), defined by the presence of polymorphonuclear leukocytes within the fetal membranes [5], is a common finding in preterm deliveries [6,7,8] that has been linked to poor outcomes including bronchopulmonary dysplasia [9], intraventricular hemorrhage [10], periventricular leukomalacia, cerebral palsy [11, 12], and EOCS [13, 14] The majority of these morbidities are thought to be related to the fetal inflammatory response and production of pro-inflammatory cytokines associated with exposure to chorioamnionitis in utero [15,16,17]. Histologic chorioamnionitis (HCA) is known to be associated with poor outcomes in preterm infants, its clinical significance among term infants is not clearly known

Objectives

Results

Conclusion