Incidence Of Neonatal Infection Research Articles

Kejadian Ketuban Pecah Dini terhadap Infeksi Neonatorum di Ruang Perinatologi RSUD Kota Madiun

Premature Rupture of Membranes (PRM) the rupture of the amniotic membrane before delivery can have consequences for the mother and baby, and can result in neonatal infections. The aim of the study was to determine the relationship between the incidence of premature rupture of membranes and the incidence of neonatal infections in Perinatology at the Madiun City General Hospital. Type of research is correlation analytic, retrospective cohort research design with a documentation study approach. The population was all newborn babies whose mothers experienced PROM from July 2022 to July 2023. The sample was 158 mothers who gave birth using simple random sampling. Research in the Perinatology Room at Madiun City Regional Hospital starting in August 2023. Independent variable is premature rupture of membranes. Neonatal infection research variables. Analysis tests using the Chi Square Test. The results of the research that almost all respondents had a duration of KPD ≥ 12 hours, 146 people (92.4%), almost all respondents experienced neonatal infections, 124 people (78.5%), the Chi Square test produced Sig. (2-tailed) is 0.013, meaning there is a relationship between the incidence of premature rupture of membranes and the incidence of neonatal infection in the Madiun City Regional Hospital with a very weak relationship level because the relationship value is 0.195. Mothers who gave birth to KPD ≥ 12 hours did not cause neonatal infections, namely that health workers increased their self-protection to prevent infection in newborns by not frequently carrying out internal examinations on women who gave birth who experienced KPD, giving antibiotics and you need to wash your hands properly

Outcome of neonates born to mothers with premature rupture of membranes

Premature rupture of membranes (PROM) is a syndrome characterized by rupture of the fetal membranes before labour. Acute chorioamnionitis complicates 0.5% - 10% of all pregnancies but the incidence may be as high as 3-25% in pregnancies complicated by PROM of more than 24 hours duration. Intrauterine infection specially chorioamnionitis is one of the most serious problems found by the practicing Obstetrician and subsequently by the Pediatrician. The incidence of neonatal infection for infants born to women with PROM range from 1 – 2.6%. To know the incidence, clinical course, outcome of early onset sepsis following PROM more than 18 hours. Materials & Methods: This is a prospective study conducted from December 2018 to September 2020 in SCB Medical College and Hospital and SVPPGIP Cuttack. All neonates born to healthy mothers with PROM more than 18 hours during their hospital stay were studied. 53.3% of the cases had Premature rupture of membranes of 18-24 hours duration,38.3% cases had Premature rupture of membranes of 24 to 72 hour and 8.4 % cases had Premature rupture of membranes of more than 72 hr. RDS was the most common clinical manifestation (37.5%) followed by septicemia (10%), meningitis (1.7%) and pneumonia 1.7%. Most common organisms isolated in blood culture were Staphylococcus followed by Klebsiella, E. coli, Pseudomonas. The incidence of neonatal infection in neonates born to mothers with PROM was 10%. Premature rupture of membranes is responsible for increased perinatal morbidity among preterm neonates & directly proportional to duration of PROM.

Incidence of urinary tract infection in neonates with significant indirect Hyperbilirubinemia of unknown etiology: case-control study

BackgroundIndirect hyperbilirubinemia is frequently encountered during neonatal period. Although it has different causes, in some cases it can’t be explained. Previous studies have illustrated that jaundice could be a major sign of urinary tract infection (UTI) in neonates.Aim of the workWe aimed to determine the association between UTI and significant unexplained neonatal indirect hyperbilirubinemia.MethodsThis prospective controlled study was performed on 150 neonates divided in two groups (100 as cases and 50 as controls) to investigate the incidence of UTI in neonates with significant unexplained hyperbilirubinemia. Urine sample was obtained using urine catheterization technique from neonates and full urine analysis was done and cases with pyuria had urine culture to confirm UTI. Immediate renal ultrasonography (USG) was performed for neonates with UTI.ResultsUTI incidence was 11% in cases while none of neonates in control group had UTI with statistical significance between cases and controls (P value < 0.05). The most common (36.4%) pathogen was Escherichia coli. Posterior urethral valve with mild hydronephrosis was diagnosed in 18.2% of UTI positive patients by renal ultrasonography.ConclusionIn neonates with unexplained indirect hyperbilirubinemia, UTI should be considered as a pathological cause.

Epidemiology of neonatal infections in hospitals of Nepal: evidence from a large- scale study

BackgroundEvery year, neonatal infections account for approximately 750,000 neonatal deaths globally. It is the third major cause of neonatal death, globally and in Nepal. There is a paucity of data on clinical aetiology and outcomes of neonatal infection in Nepal. This paper aims to assess the incidence and risk factors of neonatal infection in babies born in public hospitals of Nepal.MethodsThis is a prospective cohort study conducted for a period of 14 months, nested within a large-scale cluster randomized control trial which evaluated the Helping Babies Breathe Quality Improvement package in 12 public hospitals in Nepal. All the mothers who consented to participate within the study and delivered in these hospitals were included in the analysis. All neonates admitted into the sick newborn care unit weighing > 1500 g or/and 32 weeks or more gestation with clinical signs of infection or positive septic screening were taken as cases and those that did not have an infection were the comparison group. Bivariate and multi-variate analysis of socio-demographic, maternal, obstetric and neonatal characteristics of case and comparison group were conducted to assess risk factors associated with neonatal infection.ResultsThe overall incidence of neonatal infection was 7.3 per 1000 live births. Babies who were born to first time mothers were at 64% higher risk of having infection (aOR-1.64, 95% CI, 1.30–2.06, p-value< 0.001). Babies born to mothers who had no antenatal check-up had more than three-fold risk of infection (aOR-3.45, 95% CI, 1.82–6.56, p-value< 0.001). Babies born through caesarean section had more than two-fold risk (aOR-2.06, 95% CI, 1.48–2.87, p-value< 0.001) and babies with birth asphyxia had more than three-fold risk for infection (aOR-3.51, 95% CI, 1.71–7.20, p-value = 0.001).ConclusionAntepartum factors, such as antenatal care attendance, and intrapartum factors such as mode of delivery and birth asphyxia, were risk factors for neonatal infections. These findings highlight the importance of ANC visits and the need for proper care during resuscitation in babies with birth asphyxia.

Risk scoring and prediction of early onset septicaemia in neonates through study of perinatal factors

Background: Diagnosis of early onset septicaemia is often difficult due to lack of specificity of clinical manifestations. Being a common but neglected problem, the present study was undertaken to develop a scoring system which can predict early neonatal septicemia.Methods: 300 newborns born out of consecutive deliveries were assessed for the total score as combination of physical factors and neuromuscular factors. Information for perinatal factors was collected on a prepared pro forma by questionnaire method. Data was tabulated and subjected to statistical analysis.Results: Incidence of neonatal infection was higher in the presence of birth asphyxia, unclean vaginal examination, presence of foul smelling vaginal discharge, or when duration of labour exceeded 24 hours as compared to prolonged rupture of membranes. Incidence of infections among babies born before 37 weeks gestation or having a birth weight of 2 kg or less was nearly the same as in the cases of premature rupture of membranes (PROM). 224 cases got score 0-3 and only 0.6% got infected, whereas out of 62 cases with score 4-5, 51.6% were infected and 14 out of 14 having score of 6 or more had infection. The sensitivity of scoring system was 96%, specificity 90%, positive predictive value of 88% and negative predictive value of 60.5%.Conclusions: Besides PROM there are many other perinatal factors which are of significance in relation to early onset infections. This led to the formulation of the presenting scoring system. Validation of this scoring system through further studies can help in early diagnosis, administration of proper antibiotics and inhibition of the irrational use of antibiotics.

Neonatal Infections: a 5-Year Analysis in a Neonatal Care Unit in North East of Iran

Background: Neonatal infections are one of the major causes of death in Iran. Since identifying the risk factors, types, site, bacterial causes, and case fatality rate of an infection can be effective in selecting preventive and therapeutic methods, and appropriate supportive measures, this study aimed to investigate the aforementioned factors in the neonatal intensive care unit (NICU) of Ghaem Hospital in Mashhad- Iran during a 5-year period.Materials and Methods: This cross-sectional study was conducted from Jan 2010 to Jun 2016 on 221 infants diagnosed with infections (positive blood, cerebrospinal fluid, or urine cultures, and radiographic evidence of lung infection as well as laboratory and clinical evidence of infection). Data collection tools consisted of a researcher-made questionnaire including maternal and neonatal characteristics and clinical and laboratory evaluation. Moreover, the infants were followed up until hospital discharge or death. Data were analyzed using SPSS-16.Results: The incidence of neonatal infection was 11.6%. About 70% of the infants were born preterm and 52% of the infected infants were born by cesarean. The most common pathogens of sepsis were gram-negative bacteria (55%), coagulase-negative staphylococci (35%) and other gram-positive bacteria (10%). There were three main causes of infection of central nervous system (CNS): Klebsiella (66%), Escherichia coli (17%), and Acinetobacter (17%). Infant mortality rate due to infection was 28.1%. The causes of death included meningitis (60%), sepsis (27%), and UTI (16%).Conclusion: According to our study, the prevalence of infection and mortality rate in our ward is higher compared to developed countries. The most common cause of infections was gram-negative bacteria, but coagulase-negative staphylococci become more prevalent and needs more attention.

Incidence of Neonatal Infection in South Sinai, Egypt

Background: The incidence of neonatal infection varies from one place to another, and also within the same nursery depending on conditions predisposing to infection. Objectives: The current study aimed to determine the incidence of neonatal infection (NICUs) in South Sinai neonatal intensive care units, Egypt. Methods: The study included 1023 neonates admitted to neonatal intensive care units in the South Sinai state hospitals from January 2010 to September 2014 and scanned for demographic data and the potential risk factors for neonatal septicemia. Results: The Incidence of septicemia in the NICUs of South Sinai state hospitals was 8.6% and mortality rate among sepsis cases (sepsis fatality rate) was about 25%. The percentage of cases with late-onset sepsis (68.2%) was predominant compared to the early-onset sepsis (31.8%). Hospital acquired infections represented 30.7 % of sepsis cases. Male neonates, preterm, low birth weight babies, normal vaginal deliveries, twin deliveries and multipara mothers and premature rupture of membranes were significantly associated with more incidence of sepsis among the study population. There was no statistical significant difference (P > 0.05) between sepsis and non-sepsis cases regarding the maternal age, site of delivery and presence of congenital anomalies among the study population. Conclusions: Prevalence of septicemia in neonatal intensive care units in South Sinai state hospitals was about 8.6% due to the abundance of risk factors in this area.

Amnioinfusion for chorioamnionitis.

Amnioinfusion for chorioamnionitis.

Incidence of morbidity and mortality in neonate born to mothers with premature rupture of membranes

Background: Preterm premature rupture of membranes (PPROM) refers to PROM prior to 37 weeks of gestation. Premature rupture of membranes (PROM) is one of the most common problems in obstetrics complicating approximately 5-10% of term pregnancies. The objective of this study was to know the incidence of early onset sepsis following PROM (premature rupture of membranes) more than 18 hours, mortality among neonates born to mothers with PROM more than 18 hours. Methods: The study was conducted in department of pediatrics, Dr. Panjabrao Deshmukh memorial medical college and hospital, Amravati. All neonates born to healthy mothers with PROM more than 18 hours during their hospital stay were studied. An allowable error sample size of 60 was calculated. Detailed birth history including resuscitation details, APGAR score and gestational age assessment were evaluated. In examination of the neonate, the pulse, respiratory rate, CFT and temperature were noted followed by systemic examination. Required investigations were done for the neonate and were followed during their hospital stay. All the details were fed into the preformed teacher-made proforma . Results: 51.7% of the neonates were males and 48.3% were females. 65% of the total neonates were born by normal vaginal delivery and 35% were delivered by caesarean section. 53.3% of the cases had premature rupture of membranes of 18 - <24 hours duration, 38.3% cases had premature rupture of membranes of 24 to 72 hours and 8.3% cases had premature rupture of membranes of more than 72 hours. RDS was the most common clinical manifestation (36.7%) followed by septicemia (8.3%), meningitis (1.7%) and pneumonia (1.7%). Conclusions: Premature rupture of membranes is a high-risk obstetric condition. Active management is needed to enable delivery within 24 hours of premature rupture of membranes as it offers better neonatal outcome. Morbidity increases as the duration of premature rupture of membranes increases. The incidence of neonatal infection in neonates born to mothers with PROM was 8.3%. CRP was positive in 30% of cases. Out of 60 cases 1.7% had leucopenia and 18.3% had leucocytosis. Most common organisms isolated in blood culture were staphylococcus followed by Klebsiella, E. coli, pseudomonas and coagulase negative Staphylococci.

Airway Mucosal Immune-suppression in Neonates of Mothers Receiving A(H1N1)pnd09 Vaccination During Pregnancy

It is recommended to vaccinate pregnant women against influenza. A possible impact on the immune expression of the fetus has never been studied. We aim to study the immune signature in the upper airways and the incidence of infections in neonates born to mothers receiving Influenza A(H1N1)pnd09 vaccination during pregnancy. One hundred and fifty-six women from the unselected Copenhagen Prospective Study on Asthma in Childhood (COPSAC2010) received Influenza A(H1N1)pnd09-vaccination during the 2009 pandemic. Fifty-one mothers received the vaccine during pregnancy and 105 after pregnancy; 332 neonates of nonvaccinated mothers were included as secondary controls. Nasal mucosal lining fluid was sampled in 488 neonates and assessed for interleukin (IL)-12p70, IP-10, interferon-gamma (IFN)-γ, tumor necrosis factor-alpha (TNF)-α, MIP-1β, MCP-1, MCP-4, IL-4, IL-5, IL-13, eotaxin-1, eotaxin-3, TARC, MDC, IL-17, IL-1β, IL-8, transforming growth factor beta (TGF)-β1, IL-10 and IL-2. Infections were monitored the first year of life by daily diary cards and clinical controls. Neonates of mothers vaccinated during pregnancy had significant up-regulation of TGF-β1 [ratio = 1.52 (1.22-1.90), P = 0.0002], and corresponding down-regulation (P < 0.05) of IL-12p70, IFN-γ, IL-5, eotaxin-1, TARC, MDC, IL-8 in comparison to those vaccinated after pregnancy. The lag-time from vaccination during pregnancy to assessment of the immune signature showed significant and positive association to up-regulation of TGF-β1 levels (P = 0.0003) and significant negative association to other mediators. The study was not powered to study differences in the incidence of infections in early infancy which did not differ between the study groups. Influenza A(H1N1)pnd09 vaccination during pregnancy up-regulates TGF-β1 and down-regulates key mediators of the protective immunity.

Drug addiction during pregnancy – Risk factor for perinatal infections

Introduction. Neonatal infections are a major causes of neonatal morbidity and mortality. Pregnancy complicated by illicit drug abuse is a risk for perinatal infection. Objective. To assess the incidence of early-onset neonatal sepsis (the first 7 days of life) in newborns from high-risk pregnancies for perinatal infections: the ones affected by drug abuse, without medical assistance versus clinical and fully investigated pregnancies. Material and methods. Retrospective study on newborns from “IOMC – “Gh Polizu” Emergency Clinical Hospital of Obstetrics and Gynaecology”, Bucharest, sorted in two separate groups: one of 25 newborns, from 2005 to 2012, coming from uninvestigated pregnancies in women with illicit drug dependencies and another of 50 newborns from properly managed pregnancies from the clinical and anamnestic point of view, but with known risk factors for perinatal infections. The data has been statistically analyzed (correlation tests: Student T, Fisher exact, chi-square). Results. The incidence of newborns from pregnancies affected by drug abuse was 0,09% in all 28489 newborns, the highest percentage of 0,2% being recorded in 2011. Statistically significant differences between the two groups of newborns with risk factors for perinatal infections (emerged from uninvestigated pregnancies with drug abuse and respectively from investigated pregnancies) were: the age of the mothers – lower in drug addicted mothers (p_value 0,0002), the percentage of congenital infections (p_value 0,00003; OR 0,03; 95%CI) and respectively the mean length of hospital stay-days (p_value0,0180) higher in dug addicted mothers. On the other hand: the delivery by cesarean section (p_value 0,0010), urogenital colonization (p_value 0,0016) were more frequent in newborns from investigated pregnancies. A percent of 22 of all investigated women were positive for Group B Streptococcus and the most frequent type was I b type. The share of perinatal infections among neonatal morbidity was 33% for the newborns from drug addicted mothers and 27% for the newborns from investigated mothers. The incidence of neonatal infections was 52% for the newborns from drug addicted mothers (a risk of 1 in 1,9 cases) and 18% for the newborns from investigated mothers (a risk of 1 in 5,5 cases). Conclusions. Drug addiction during pregnancy represents a high risk factor for perinatal infections due to sexual and blood transmitted diseases associated with lack of hygiene, precarious nutrition and low immunological status and leads to high medical and social costs. The correct medical management of pregnancies, through early diagnosis and treatment of neonatal infections may lower the incidence and the consequences of perinatal infections.

Antibiotics on incidence of infection in neonates with meconium-stained amniotic fluid

Background The effectiveness of antibiotics for preventinginfection in neonates with meconium-stained amniotic fluid(MSAF) remains unclear. Not all neonates with MSAF developmeconium aspiration syndrome (MAS) or neonatal infection.Furthermore, neonatal infection diagnosis may be difficult dueto lack of symptoms. As such, clinical manifestations, laboratoryresults, and infection markers are important for diagnosis.Objective To evaluate antibiotic use on the incidence ofinfectionin neonates with MSAF.Methods This double-blind randomized controlled clinical trialwas performed at Dr. Kariadi Hospital, Semarang, Indonesia fromOctober 2009 to March 2010. Subjects were newborns with MSAFwho were diagnosed by two observers (Kappa test intraobserveragreement was 0.74) and with feces metabolites found in theiramniotic fluid. Sixty-nine newborns were divided into groups Iand II, comprised of 35 and 34 subjects, respectively. Group Isubjects (control group) were not given antibiotics, while groupII subjects (treatment group) were given combination antibioticsof ampicillin (50 mg;kg BW) and gentamicin (8 mg;kg BW), assingle doses. Neonatal infection diagnosis was based on clinicalmanifestations, laboratory results (leucocyte count, blood culture,and I: T ratio), and the following infection markers: procalcitonin(PCT), interleukin-6 (IL-6), tumor necrosis tumor-a (TNF-a),and C-reactive protein (CRP). Chi-square and Fischer's exacttests were used for statistical analyses.Results We found no significant differences in the incidence ofneonatal infection between those who received and those whodid not receive antibiotics, based on clinical manifestations, thefirst and second examination of laboratory marker (P=0.53),examinations of CRP, IL-6, TNF-a, and PCT either as singlemarkers or combinations of 2, 3, or 4 markers (P&gt; 0.05) , as wellas mortality rate (P=0.30).Conclusion There is no significant difference in the incidenceof infection in neonates with MSAF who received prophylactic antibiotics compared to those who did not receive antibiotics.

Antibiotics on incidence of infection in neonates with meconium-stained amniotic fluid

Antibiotics on incidence of infection in neonates with meconium-stained amniotic fluid

1175 Pathogens Which Causing Neonatal Infection in Meconium Stained Amniotic Fluids

BackgroundFew studies considered that amniotic fluid is sterile but some others mentioned that contains pathogens. Even though not all meconium stained amniotic fluids MSAF develop into neonatal infection, it is...

Burden of Neonatal Infections in Developing Countries

Infections are a major contributor to newborn deaths in developing countries. Majority of these deaths occur at home without coming to medical attention. The Millennium Development Goal for child survival cannot be achieved without substantial reductions in infection-specific neonatal mortality. We describe the burden of neonatal infections in developing countries and discuss the need for community-based management approaches to improve survival from neonatal infections in these countries. We reviewed community-based studies published since 1990 from developing countries to estimate the rates of neonatal and young infant infections and infection-specific neonatal mortality. Thirty-two studies reviewed suggest that infections may be responsible for 8% to 80% of all neonatal deaths and as many as 42% of deaths in the first week of life. Eleven reports provided data on incidence of infections in neonates and infants up to 60 days of life. Rates of neonatal sepsis were as high as 170/1000 live births (clinically diagnosed) and 5.5/1000 live births (blood culture-confirmed). Considerable heterogeneity exists among included studies, and more accurate data and standardized methodologies are required. However, data indicate that a significant proportion of neonatal deaths in developing countries are due to infections. Current recommendations of hospitalization and parenteral therapy for managing neonatal infections are inadequately followed in developing countries. Approaches for detecting and managing serious infections within the community, at home or first-level health facilities, may be more effective options in settings where delays and reluctance to seek care, health system inefficiencies, socioeconomic and cultural, as well as logistic constraints exist.

Risk Factors for Neonatal Infections in Full-term Babies in South Korea

PurposeSince 1997, private postnatal care facilities (San-hu-jo-ri-won in Korean) have emerged to take the role of the family. As a result, neonates are now exposed to many people and are very vulnerable to infection. However, there has been no study on the influence of postnatal care facilities on neonatal infection. The aim of this study was to determine the risk factors of neonatal infection in full-term babies in Korea.Materials and MethodsWe followed up 556 pregnant women and their babies for 4 weeks after their births at 2 hospitals in Seoul and Daejeon from October 2004 to September 2005. Among 512 full-term babies, 58 had infectious diseases. To determine the risk factors for infection, 53 infected neonates at 4 - 28 days of life and 413 healthy neonates were compared.ResultsThe incidence of neonatal infection at 4 to 28 days after birth was 10.5%. After adjusting the related factors, the number of siblings (OR = 2.05, 95% CI = 1.13 - 3.71 for 1 or more) and postnatal care facilities or home aides (OR = 1.91, 95% CI = 1.07 - 3.45) were significant risk factors. Formula or mixed feeding (OR = 1.66, 95% CI = 0.91 - 3.04) increased the risk of neonatal infection but it was not statistically significant.ConclusionWhen the newborns had siblings, stayed at postnatal care facilities, or were cared for by home aides, the risk of neonatal infections significantly increased. Further research on the feeding effect on neonatal infection and evaluation of prevention efforts are needed.

Serious bacterial infections in newborn infants in developing countries.

The overwhelming majority of the world's annual 4 million neonatal deaths occur in developing countries. This review therefore briefly addresses the burden, aetiology, prevention and management of serious neonatal bacterial infections in low-income settings. Bacterial infection is the biggest cause of neonatal admissions to hospitals, and probably the biggest cause of morbidity in the community, but its burden is unclear. The commonest serious infections involve bacteraemia, meningitis and respiratory infection, and case fatality rates may be as high as 45%. Key pathogens are Escherichia coli, Klebsiella species, Staphylococcus aureus and Streptococcus pyogenes. The incidence of neonatal infections with group B streptococcus is highly variable, as is the spectrum of antimicrobial resistance. Current areas of research include the rectification of micronutrient deficiencies, neonatal skin care, appropriate breastfeeding recommendations, cleansing of the birth canal, and simplified methods of diagnosis of infection. Operational activities include the control of neonatal tetanus, the diagnosis and treatment of sexually transmitted infections, integrated strategies for improving pregnancy, childbirth and neonatal survival, community-based management of acute respiratory infections, and community-based management of neonatal sepsis.

Chlorhexidine Vs. Sterile Vaginal Wash During Labor to Prevent Neonatal Infection

Objective: The purpose of this study was to determine if a dilute solution of chlorhexidine used as a one-time vaginal wash intrapartum can reduce the use of postnatal antibiotics and neonatal infection. Methods: Term pregnant women in labor were prospectively randomized to receive either 20 cc of 0.4% chlorhexidine (n = 481) or 20 cc of sterile water (n = 466) placebo. Exclusion criteria included fetal distress, clinical infection, cervical dilatation >6 cm, and known allergy to chlorhexidine. Outcome variables included the incidence of neonatal pneumonia, culture proven neonatal sepsis, and use of the antibiotics in the neonate. Continuous variables were compared using the Mann-Whitney U-test and discrete variables were compared with the chi-square test. Results: The length of ruptured membranes (mean ± S.D.) between the chlorhexidine group (408 ± 589 min) and control group (352 ± 318 min) was not significantly different (P = 0.85, 95% confidence interval 354–462). Fifteen neonates (3.2%) in the chlorhexidine group and 9 (1.9%) in the control group received antibiotics in the postnatal period (P = 0.32, 95% confidence interval 0.72–3.72). There was one case of pneumonia in the control group and no cases of sepsis in either group. Conclusions: A one-time chlorhexidine vaginal wash does not decrease the use of antibiotics or incidence of neonatal infection in our population.

Chlorhexidine vs. sterile vaginal wash during labor to prevent neonatal infection

Objective The purpose of this study was to determine if a dilute solution of chlorhexidine used as a one-time vaginal wash intrapartum can reduce the use of postnatal antibiotics and neonatal infection. Methods Term pregnant women in labor were prospectively randomized to receive either 20 cc of 0.4% chlorhexidine (n = 481) or 20 cc of sterile water (n = 466) placebo. Exclusion criteria included fetal distress, clinical infection, cervical dilatation >6 cm, and known allergy to chlorhexidine. Outcome variables included the incidence of neonatal pneumonia, culture proven neonatal sepsis, and use of the antibiotics in the neonate. Continuous variables were compared using the Mann-Whitney U-test and discrete variables were compared with the chi-square test. Results The length of ruptured membranes (mean ± S.D.) between the chlorhexidine group (408 ± 589 min) and control group (352 ± 318 min) was not significantly different (P = 0.85, 95% confidence interval 354–462). Fifteen neonates (3.2%) in the chlorhexidine group and 9 (1.9%) in the control group received antibiotics in the postnatal period (P = 0.32, 95% confidence interval 0.72–3.72). There was one case of pneumonia in the control group and no cases of sepsis in either group. Conclusions A one-time chlorhexidine vaginal wash does not decrease the use of antibiotics or incidence of neonatal infection in our population. Infect. Dis. Obstet. Gynecol. 5:286–290, 1997. © 1998 Wiley-Liss, Inc.

Ampicillin prophylaxis in preterm premature rupture of the membranes: A prospective randomized study

It is hypothesized that ampicillin may treat subclinical deciduitis and prolong the "effective" latent period in patients with preterm premature rupture of the membranes. We studied 82 patients with preterm rupture of membranes who were managed expectantly and were randomly assigned either to receive ampicillin prophylaxis (n = 43) or not to receive ampicillin prophylaxis (n = 39). Patients were excluded from study entry on admission if they had suspected or frank chorioamnionitis, active preterm labor, a history of penicillin allergy, multiple gestation, or cervical cerclage. There were no significant differences between the groups in duration of membrane rupture prior to admission, gestational age at membrane rupture, use of steroids and tocolysis, and demographic factors. Life-table analysis showed that the risk of delivery was significantly lower for the group of patients receiving prophylactic ampicillin. The incidence of neonatal infection was significantly lower in the ampicillin group, 1 (2%) versus 6 (17%), p less than 0.04.