Histologic chorioamnionitis as a consideration in the management of newborns of febrile mothers

Abstract

Introduction: Chorioamnionitis (CA) presents a risk for neonatal sepsis, but its diagnosis remains a challenge. Maternal fever is often used as a clinical predictor of infection, but may be affected by other factors. There is no consensus among neonatologists regarding the length of treatment of babies born to febrile mothers with negative blood culture, but whose placentas are positive for the presence of histologic CA (HCA).Objectives: A prospective observational cohort study was conducted on term infants to determine the association of HCA with C-reactive protein (CRP) and elevated immature/total neutrophil (I/T) ratio and other perinatal factors.Methods: I/T ratio, CRP, blood culture and placental pathology were performed on 100 infants born to mothers with temperature ≥100.4 °F. Placental pathology performed on 100 control infants born to afebrile mothers.Results: There was a significant association between HCA and maternal fever (MF). The presence of elevated CRP was associated with HCA. There was no significant association between HCA and anesthesia, mode of delivery, nor elevated I/T ratio.Conclusions: Maternal fever is associated with HCA. The HCA in conjunction with an elevated CRP can guide the duration of antimicrobial therapy in infants born to febrile mothers.