Maternal Fever Research Articles

The Adverse Outcomes of Chorioamnionitis on the Pregnant Female and Their Fetus

Introduction: Chorioamnionitis is an intra-amniotic infection caused by an ascending polymicrobial bacterial infection. Triple I (intrauterine inflammation or infection or both) is also proposed to replace chorioamnionitis due to its imprecise definition and variable clinical manifestations. Intraamniotic infection is characterized by inflammation of the amniotic fluid, placenta, fetus, fetal membranes, or decidua. Maternal fever, uterine tenderness, maternal tachycardia, fetal tachycardia, and purulent fluid coming from the cervical os (the cervical opening can be external, near the vagina, or internal, near the uterus) are the key clinical findings that are crucial for the diagnosis of clinical chorioamnionitis. Clinically, intra-amnionitic infections have been linked to severe morbidity and death in pregnant women, fetuses, and newborns. Method: A systematic search of PubMed, Embase, LitCovid, MedRxiv, BioRxiv, Google Scholar, EBSCO MEDLINE, CINAHL and Scopus electronic database was done using key words like Chorioamnionitis, adverse complication in pregnancy to mother and her fetus associated with intrauterine infection, Intraamniotic inflammation and triple I. Studies have been included from January 2015 to December 2022. Result: Chorioamnionitis is most typically caused by ascending infection and is frequently linked with premature membrane rupture. Chorioamnionitis is typically caused by a polymicrobial infection, with Ureaplasma urealyticum, Mycoplasma hominis, and Gram-negative anaerobes being common pathogens. Antimicrobial drugs, antipyretics, rapid treatment, and supportive care are the mainstays of management. Conclusion: Overall, this review provides a better understanding of Chorioamnionitis and its potential impact on public health. By shedding light on this emerging disease, we hope to contribute to ongoing efforts to prevent and treat of this serious disorder. Keywords: Chorioamnionitis, Intrauterine Infection, Pregnancy, adverse complication, Triple I, Intraamniotic Inflammation

COVID-19 Omicron variant infection has minimal impact on maternal and neonatal outcomes: A cross-sectional cohort study.

To explore the impact of the Omicron variant on maternal and neonatal outcomes. Cross-sectional cohort study of women giving live birth in a single hospital in Shanghai in December 2022. Demographic characteristics, maternal and neonatal outcomes and laboratory testing results were retrieved from medical records. Propensity score matching was used to match COVID-19-positive and -negative women. Differential analysis was used to assess associations between COVID-19 and in-hospital maternal and neonatal outcomes. A total of 1508 women were included, comprising 729 natural births, 741 caesarean sections and 38 forceps deliveries. After 1:1 matching, 310 clients were included for analysis with each 155 in COVID-19-positive and -negative groups. Higher maternal fever was found in all modes of delivery, and higher preterm birth and lower pH value of blood gas of the umbilical artery in the vaginal delivery subgroup (p < 0.05). Other maternal and neonatal outcomes showed no significant difference between COVID-19-positive and -negative clients.

Development and validation of a predictive model for early diagnosis of neonatal acute respiratory distress syndrome based on the Montreux definition.

Based on the Montreux definition, we aim to develop and validate a predictive model for the early diagnosis of neonatal acute respiratory distress syndrome (ARDS). A retrospective analysis of clinical data on 198 neonates with respiratory distress from January 2018 to January 2022 was conducted. Neonates meeting Montreux definition were classified as ARDS group (n = 79), while the rest were non-ARDS group (n = 119). Univariate analysis identified indicators for neonatal ARDS, followed by logistic regression to construct a predictive model for early diagnosis. The ability of predictors and models to predict neonatal ARDS was evaluated using area under the curve (AUC), and model performance was estimated through bootstrap resampling. Maternal prenatal fever, abnormal fetal heart beat, meconium-stained amniotic fluid (MSAF), white blood cell (WBC), absolute neutrophil count (ANC), neutrophil percentage (NE%), platelet count (PLT), C-reactive protein (CRP), procalcitonin (PCT), creatine kinase (CK), activated partial thromboplastin time (APTT), serum calcium (Ca) and sodium (Na)exhibited significant differences between the ARDS group and the non-ARDS group (P < 0.05). MSAF (OR=5.037; 95% CI: 1.523-16.657; P < 0.05), ANC (OR = 1.324; 95% CI: 1.172-1.495; P < 0.05), PLT (OR = 0.979; 95% CI: 0.971-0.986; P < 0.05), Ca (OR = 0.020; 95% CI: 0.004-0.088; P < 0.05) emerged as independent risk factors for the development of ARDS. The respective AUC values for MSAF, ANC, PLT, Ca, and the combined prediction models were 0.606, 0.691, 0.808, 0.761 and 0.931. Internal validation showed that the C-index for the model was 0.931. Early application of the model combining MSAF, ANC, PLT and Ca may have a good predictive effect on the early diagnosis of neonatal ARDS.

Understanding the Drivers Behind Neonatal Sepsis Rates among Immunized and Outpatient Neonates at Hoima Regional Referral Hospital, Western Uganda

Neonatal sepsis is a major cause of neonatal mortality in developing countries, accounting for a significant portion of annual infant deaths. This study investigated the determinants influencing the occurrence of neonatal sepsis among infants at Hoima Regional Referral Hospital in Western Uganda. The study revealed an overall neonatal sepsis prevalence of 12.5%, with 65% and 35% of cases classified as early-onset and late-onset sepsis, respectively. Factors significantly associated with neonatal sepsis included neonatal age, maternal history of fever, dysuria, and maternal/caretaker hygiene. The study emphasizes the importance of caretaker/mother's age, maternal fever history, dysuria, and hygiene in contributing to neonatal sepsis. Prevention strategies should prioritize addressing these risk factors rather than solely focusing on post-occurrence treatment. Proactive measures are advocated to mitigate the incidence of neonatal sepsis. Keywords: Neonatal sepsis, Immunization, Childhood mortality, Maternal/caretaker’s hygiene, maternal history of fever

Clinical characteristics of preterm and term infants with Ureaplasma in gastric fluid

Ureaplasma spp. is an endemic microorganism that causes placental chorioamnionitis or preterm delivery in pregnant women, and the occurrence of bronchopulmonary dysplasia or intraventricular hemorrhaging in preterm infants after birth, although the pathogenicity of Ureaplasma remains controversial. The association between Ureaplasma exposure and the symptoms or outcomes of infected mothers or their infants born at term remains poorly understood. We investigated the clinical characteristics of preterm and term infants with or without Ureaplasma in their gastric fluid. Gastric fluid samples were collected from 47 newborns in the neonatal intensive-care unit immediately after birth and tested using multiplex polymerase chain reaction (PCR) assays targeting Ureaplasma spp., Ureaplasma parvum, and Ureaplasma urealyticum. The clinical findings and outcomes of the neonates and their mothers were retrospectively evaluated. Ureaplasma spp. were detected in 9/47 samples (19%) by multiplex PCR assays. In all cases, the subspecies was U. parvum. The Ureaplasma-positive group had a significantly higher incidence of chorioamnionitis in utero than the Ureaplasma-negative group. Regarding preterm infants, the IgM levels in the Ureaplasma-positive group were significantly higher than in the Ureaplasma-negative group. In contrast, in term infants, the rates of a non-reassuring fetal status, a maternal fever, and maternal leukocyte counts and maternal C-reactive protein levels within five days before delivery in the Ureaplasma-positive group were significantly higher than those in the Ureaplasma-negative group. All three extremely-low-birth-weight infants with Ureaplasma developed bronchopulmonary dysplasia. The length of hospitalization in the Ureaplasma-positive group was almost same as that in the Ureaplasma-negative group for term infants. Mothers or their fetuses with exposure to Ureaplasma expressed characteristic clinical features during pregnancy and after birth.

Maternal intrapartum fever during epidural labour analgesia: Incidence and influencing factors.

The management and nursing care of women's temperature during delivery is an important part of clinical obstetrics. We aimed to evaluate maternal intrapartum fever during epidural labour analgesia to provide evidence for the management and care of women in labour. This study was conducted and reported according to the STROBE statement. Women in labour undergoing epidural labour analgesia in our hospital from 1 January 2021 to 31 August 2022 were retrospectively selected. The characteristics of women in labour with and without intrapartum fever were compared. Pearson correlation and logistic regression analysis were used to analyse the influencing factors of postpartum fever. A total of 196 women in labour were included, the incidence of maternal intrapartum fever in women in labour undergoing epidural analgesia was 27.5%. Pearson correlation analyses showed that BMI, oxytocin use, labour duration, number of vaginal examinations, time from rupture of the foetal membranes to the end of labour and duration of epidural analgesia were all correlated with the occurrence of intrapartum fever (all P < 0.05). Logistic regression analyses indicated that body mass index ≥28 kg/m2 (OR = 1.825), oxytocin use (OR = 2.082), labour duration ≥9.2h (OR = 2.613), number of vaginal examinations ≥8 (OR = 2.044-3.115), the time from rupture of the foetal membranes to the end of labour ≥250 min (OR = 2.766) and duration of epidural analgesia ≥300 min (OR = 3.106) were risk factors for intrapartum fever in women in labour undergoing epidural analgesia (all P < 0.05). Maternal intrapartum fever in women in labour undergoing epidural analgesia is common and influenced by many factors. Nurses should take early preventive care measures according to these factors during epidural analgesia in labour.

Association of clinical signs of chorioamnionitis with histological chorioamnionitis and neonatal outcomes in women with premature rupture of membranes.

Premature rupture of membrane (PROM), especially when preterm or prolonged is associated with an increased risk of chorioamnionitis with its attendant feto-maternal complications. The study was aimed to determine the association of clinical signs of chorioamnionitis with histological chorioamnionitis and neonatal outcomes in women with PROM. Eligible participants with clinical diagnosis of PROM at gestational age of ≥28 weeks managed between December 2018 and June 2019 were consecutively recruited. Their sociodemographic characteristics, obstetrics history, and evidence of clinical chorioamnionitis using the Gibb's criteria were obtained. Following delivery, chorioamnionitis was histologically confirmed. Primary outcome measure was the proportion of women with PROM and histological chorioamnionitis that were detected clinically. Of the 136 participants analyzed, 108 (79.4%) had term PROM, while 28 (20.6%) had preterm PROM (<37 weeks). The prevalence of histological chorioamnionitis was 50.0% compared to 16.2% using clinical indicators of infection. Histological chorioamnionitis was almost two times higher in preterm than term PROM (71.4% vs 38.9%). About two-third (67.6%) of the chorioamnionitis identified histologically were missed using clinical signs of chorioamnionitis. Clinical signs of chorioamnionitis had specificity of 100.0%, but low sensitivity (35.5%) and accuracy of 70.6%. A combination of three symptoms, maternal pyrexia and tachycardia, and fetal tachycardia appears to be the most reliable clinical indicator of chorioamnionitis in women with preterm PROM. There was a significant association between low birth weight, low Apgar score, NICU admission, and the presence of histological chorioamnionitis in women that had PROM. Clinical signs of chorioamnionitis have a low sensitivity and are not very accuracy in diagnosing chorioamnionitis in women with PROM.

Safety and Effect of the Use of Hydrotherapy during Labour: A Retrospective Observational Study.

Hydrotherapy is a technique used for pain management during labour, but its safety for both the mother and foetus remains uncertain. The main aim of this study is to determine whether the use of hydrotherapy in the first stage of labour is safe for both the mother and newborn. A retrospective observational study was conducted to collect data from the partogram, maternal and neonatal history. A total of 377 women who gave birth at the Costa del Sol Hospital in Malaga between January 2010 and December 2020 were randomly selected. They were divided into a control group (253 women) and an intervention group (124 women) that used hydrotherapy in the first stage of labour. There were no significant differences between the groups in terms of age, history of previous miscarriages, type of delivery, or newborn weight. The results showed that most women who opted for hydrotherapy were nulliparous, and the use of hydrotherapy during labour was safe for both the mother and foetus. There were no significant differences in the variables of maternal arterial hypotension, postpartum haemorrhage, postpartum maternal fever, foetal complications, neonatal admission, 1 and 5 min Apgar scores, umbilical arterial or venous pH, or foetal cardiotocographic recording. However, there was a significant difference (p = 0.005) in the rate of breastfeeding among mothers who opted for hydrotherapy (96% vs. 85.7%). The use of hydrotherapy during the first stage of labour is safe and is associated with increased breastfeeding rates compared to conventional delivery.

Interventions for the Prevention or Treatment of Epidural-related Maternal Fever: A Systematic Review and Meta-analysis

(British Journal of Anaesthesia. 2022;129:567e580) Epidural-related maternal fever (ERMF) occurs in 15% to 25% of laboring women who receive analgesia. ERMF is not seen in non-pregnant or pregnant women who are not in labor. The cause behind ERMF is not yet understood. There have been studies on a number of preventative interventions for ERMF. This systematic review aimed to compare the effectiveness of proposed interventions, primarily in terms of the incidence of ERMF, and secondarily, by comparing the incidence of neonatal sepsis evaluation and neonatal admission to level 2 care.

First and second-trimester biochemical serum markers in maternal familial Mediterranean fever: The impact of colchicine use

IntroductionWe aimed to investigate the effects of colchicine use on first and second trimester screening markers in pregnancies complicated with familial Mediterranean fever (FMF) and to evaluate the overall impact of these effects on perinatal outcomes. MethodsA retrospective case-control study was conducted in pregnancies complicated with FMF using colchicine and healthy pregnancies as controls without any defined risk factors and medication use. Biochemical markers for the aneuploidy screening, including free ß-hCG and PAPP-A in the first trimester, and AFP, HCG, and unconjugated estriol (uE3) in the second trimester, were recorded, and MoM levels of these markers were compared between the FMF and control groups. Obstetric history and outcomes were also compared between groups. We used propensity score matching to form a cohort in which patients had similar baseline characteristics. ResultsAmong 93 eligible pregnant women, 31 women in FMF group and 31 in control group had similar propensity scores and were included in the analyses. Levels of serum-free ß-hCG, PAPP-A and AFP were similar between FMF and control groups (p = 0.671, p = 0.387 and p = 0.963, respectively). For the second-trimester markers, maternal serum uE3 MoM level were significantly lower in the FMF group using colchicine than in the controls (p = 0.045). We also compared these markers according to the daily colchicine dose between FMF subgroups. We did not detect significant difference between the different colchicine treatment modalities (0.5–1 mg/day vs. 1.5–2 mg/day, p > 0.05). ConclusionMaternal biochemical serum markers of an aneuploidy screening test in the second trimester may be affected by FMF with colchicine use, leading to misinterpretation of the risk level of tests. For these tests with decreased uE3 levels, FMF and colchicine use should be considered as a causative etiology after ruling out common etiologies and confounding factors before recommending invasive diagnostic testing.

Risk Factors Associated with Cleft Etiology: A Multicenter Experience

Background: The etiology of cleft lip and palate is complex and thought to involve genetic influences with variable interactions from environmental factors. Although genetic and environmental triggers are important for syndromic cleft lip and palate, the etiology of the more common non-syndromic (isolated) forms remains poorly understood. Recognition of etiology, risk factors and natural history is essential to define how prevention and treatment should be planned and implemented. Objective: This study is aimed at assessing the possible risk factors in the etiology of patients presenting with cleft lip and palate. Materials and methods: A total of 254 children (children 12years and below) for cleft surgery at three surgical centers (Mercyland orthopedic Hospital, Galaxy Medical Center and shifa Royal Hospital) in the North Eastern under the Smile Train, project for a 2-year period (January 2021 to December 2022) were included in this study. A Self- administered questionnaire was prepared to fill in data about the patients' gender, family history of cleft, consanguineous marriages, maternal risk factors. Ages of the children were ascertained in months and years as told by the parents. Paternal and maternal ages were also recorded. Statistical analysis was done using the Statistical Package for Social Sciences (IBM) 23.0 version. The significant level was set at a p value of \0.05 at 95% confidence interval. Results: Median age at presentation was 4 month, varying from &lt;1 months to 12 years. The gender distribution was 133 (52.4%) males and 121 (47.6%) females (M:F = 1:0.9). Majority (214, 84.3%) of the affected children belonged to low socioeconomic group while only a few (12, 4.7%). High proportion of mothers between the age of 26 to 35 years (42.5%) was observed, but no association was found between maternal age and clefts (p=0.331). There was evidence of association between paternal age &gt;35years old and cleft (p=0.005). Conclusion: This study revealed a strong association between consanguineous marriage, low socioeconomic status and persistent maternal fever during the first trimester and cleft. Increasing paternal age was also found to increase the risk of cleft. The relevance of this study is for public health workers and clinicians to be equipped with adequate information to provide useful counseling to parents particularly those with history of cleft.it may also provide adequate information for policy makers when making policies of public health concerns.

Maternal Fever and Reduced Fetal Movement as Predictive Risk Factors for Adverse Neonatal Outcome in Cases of Congenital SARS-CoV-2 Infection: A Meta-Analysis of Individual Participant Data from Case Reports and Case Series

Objectives: To determine risk factors for primary and secondary adverse neonatal outcomes in newborns with congenital SARS-CoV-2 infection. Data sources: PubMed/MEDLINE and Google Scholar from January 2020 to January 2022. Study eligibility criteria: newborns delivered after 24 weeks of gestation with confirmed/possible congenital SARS-CoV-2 infection, according to standard classification criteria. Methods: Execution of the IPD analyses followed the PRISMA-IPD statement. Univariate non-parametric tests compared numerical data distributions. Fisher’s exact or Chi-square test determined categorical variables’ statistical significance. Multivariate logistic regression revealed risk factors for adverse neonatal outcome. Results: Maternal fever was associated with symptomatic congenital infection (OR: 4.55, 95% CI: 1.33–15.57). Two-thirds of women that reported decreased fetal movements were diagnosed with IUFD (p-value = 0.001). Reduced fetal movement increased the risk of intrauterine fetal death by 7.84 times (p-value = 0.016, 95% CI: 2.23–27.5). The risk of stillbirth decreased with gestational age at the time of maternal infection (p-value &lt; 0.05, OR: 0.87, 95% CI: 0.79–0.97). Conclusions: Maternal fever and perception of reduced fetal movement may be predictive risk factors for adverse pregnancy outcome in cases with congenital SARS-CoV-2 infection.

Doula Support and Pregnancy-Related Complications and Death Among Childbearing Women in the United States: A Scoping Review.

The potential benefits of perinatal doula support are many; however, doulas are underutilized, which may heighten pregnancy-related complications. In this scoping review, we assess the influence of perinatal doula support on pregnancy-related complications and death in the United States. We searched PubMed, CINAHL, Scopus, and Alt HealthWatch for literature on doula support and its influence on pregnancy-related complications (maternal fever or infection, postpartum hemorrhage, amniotic fluid embolism, complications from anesthesia, preeclampsia, eclampsia, cardiomyopathy, pulmonary or thrombotic embolism, and cerebrovascular accident). Peer-reviewed articles written in English and conducted in the United States from 1969 to 2021 were included. Screening at all levels was blinded. We extracted data based on title, author, year, design, population, sample size, methods, limitations, recommendations, and definition of doula support. Following removal of duplicates, review of 3679 article titles and abstracts yielded 42 articles for full-text review; 3 articles met final inclusion criteria. One included study focused on intrapartum doula support and 2 on doula support that extended throughout the perinatal period. Within the included studies, doula support was associated with decreased rates of intrapartum maternal fever and gestational hypertension; however, it was not associated with decreased rates of gestational diabetes or depression. The literature has addressed the benefits of perinatal doula support, but studies with validated tools to examine associations between doula support and pregnancy-related complications and death are lacking. The studies that addressed intrapartum and continuous doula care included large generalizable samples, from which future research can draw to improve the practice of caring for patients during the perinatal period. Extensive research shows that unfavorable conditions can influence perinatal outcomes across generations. Implementing doula support may offer a potential approach to reduce and help alleviate resulting disparities in perinatal health.

Effects of neuraxial labor analgesia on intrapartum maternal fever in full-term pregnancy and its influence on birth outcomes.

This study aimed to explore the relationship between neuraxial labor analgesia and intrapartum fever and to demonstrate the influence of maternal fever on perinatal outcomes within 6 weeks after birth. This was a secondary analysis of a multicenter prospective cohort study that enrolled women with single- and full-term cephalic pregnancy in northern China. Intrapartum maternal fever was defined as the highest axillary temperature during labor ≥37.5°C. Data on baseline characteristics, maternal variables, and neonatal outcomes were all collected. The association between neuraxial labor analgesia and intrapartum maternal fever was analyzed with logistic regression models, and the cutoff point was identified by the receiver operating characteristic curve. Of 577 parturients, 74 (12.8%) developed intrapartum fever. Neuraxial analgesia was associated with an increased risk of maternal intrapartum fever with or without adjusting for confounding factors (adjusted OR = 2.68; 95% CI: 1.32-5.47; p = 0.007). Further analysis showed that neuraxial analgesia of <5 h did not increase the risk of intrapartum fever compared with no analgesia (OR = 1.52; 95% CI: 0.63-3.64; p = 0.35), and longer neuraxial labor analgesia time (over 5 h) significantly increased the risk of fever (OR = 3.38; 95% CI: 1.63-7.01; p = 0.001). Parturients with intrapartum fever suffered more maternal adverse outcomes compared with those without fever (p < 0.001). Neonates of women with intrapartum fever had slightly higher rates of composite adverse neonatal outcomes compared with those without fever; however, the difference was not statistically significant (p = 0.098). In women with low-risk pregnancies, a longer time of neuraxial labor analgesia was associated with an increased risk of intrapartum maternal fever. Intrapartum fever was related to adverse maternal outcomes but did not significantly affect neonatal outcomes within 6 weeks after delivery.

Oxytocin Versus Oral Misoprostol for Induction of Labor in Pregnant Women with Term Prelabor Rupture of Membranes: a Randomized Clinical Trial

This study compares the effectiveness and safety of oxytocin infusion against oral misoprostol for inducing labour in pregnant women with term prelabor membrane rupture. We randomized 173 pregnant women presenting with term prelabor rupture of membranes (PROM) at Ain Shams University Maternity Hospital into Group A (underwent induction of labor (IOL) by 25μg misoprostol oral tablet every 4 h, for maximum 5 doses) and an identical Group B: (underwent IOL by oxytocin infusion according to the hospital protocol). Our primary outcome was rate of vaginal delivery within 24 h, while the secondary outcomes included the time till active phase, induction to delivery interval, maternal pyrexia, nausea and vomiting, fetal distress, Apgar score, birth weight, and neonatal intensive care unit admission. Both groups showed high rates of vaginal delivery (82.4% & 87.1% for misoprostol group and oxytocin group respectively) with no significant difference between the two groups (p=0.394). However, patients induced by misoprostol took significantly less time to reach active phase with a shorter induction to delivery interval as compared to patients induced with oxytocin. This difference was clear in multiparous women, but not observed in primiparous women when subgroup analysis was done. No significant difference was found as regards other outcomes. Our study showed that both oral misoprostol and oxytocin are effective and safe for IOL in patients with PROM, with shorter induction-delivery interval in patients induced by oral misoprostol, an effect that is clear in multiparous but not primiparous women.Trial registrationNCT05215873, on 31/01/2022, “retrospectively registered”.

Antibiotic treatment of women with isolated intrapartum fever vs clinical chorioamnionitis: maternal and neonatal outcomes

Clinical chorioamnionitis refers to the presence of maternal fever (≥38°C) and at least 2 clinical signs: (1) maternal tachycardia (>100 bpm), (2) fetal tachycardia (>160 bpm), (3) maternal leukocytosis >15,000/mm2, (4) purulent vaginal discharge, and (5) uterine tenderness. Few data exist to guide the appropriate management of women with isolated intrapartum fever in the absence of other clinical signs suggesting chorioamnionitis. This study compared maternal and neonatal infectious outcomes and microbiological outcomes between women with isolated intrapartum fever and women with clinical chorioamnionitis. This 10-year retrospective study included all the laboring women at our institution, at ≥34 weeks of gestation, with a singleton pregnancy and body temperature of ≥38.0°C, with or without other evidences of infection. According to our department protocol, women with isolated intrapartum fever received intravenous ampicillin, whereas women with clinical chorioamnionitis received intravenous ampicillin plus gentamicin. The primary outcome was puerperal endometritis, compared between women with isolated intrapartum fever (treated with ampicillin) and women with clinical chorioamnionitis (treated with ampicillin plus gentamicin). The secondary maternal outcomes consisted of (1) maternal clinical outcomes, such as cesarean delivery, surgical site infection, postpartum hemorrhage, and postpartum length of stay, and (2) microbiological studies, including positive chorioamniotic membrane swabs and blood culture. Among the secondary neonatal outcomes were early-onset sepsis, neonatal intensive care unit admission, and length of stay. Of note, 2 multivariate logistic regression models were created. A model aimed to predict puerperal endometritis controlled for gestational age of >41 weeks, diabetes mellitus, obesity, positive group B streptococcus status, rupture of membrane ≥18 hours, meconium staining, positive chorioamniotic membrane swabs, cesarean delivery, and empiric postdelivery antibiotic administration. A model aimed to predict neonatal early-onset sepsis controlled for gestational age of 34 to 37 weeks, positive group B streptococcus status, rupture of membrane ≥18 hours, and positive chorioamniotic membrane swabs. Overall, 458 women met the inclusion criteria. Compared with women with clinical chorioamnionitis (n=231), women with isolated intrapartum fever (n=227) had higher rates of puerperal endometritis (3.9% vs 8.8%; P=.03), early-onset sepsis (0.4% vs 4.4%; P=.005), positive chorioamniotic membrane swabs (46.3% vs 63.9%; P<.001), and ampicillin-resistant Escherichia coli (35.5% vs 48.9%; P=.033). The rate of group B streptococcus-positive chorioamniotic membrane swabs was similar between the groups. In a subanalysis of women with negative or unknown group B streptococcus status, the puerperal endometritis and neonatal early-onset sepsis rates were higher among women with isolated intrapartum fever than women with suspected chorioamnionitis (8.7% vs 3.3% [P=.041] and 4.1% vs 0% [P<.001], respectively). In 2 multivariate analysis models, among women with isolated intrapartum fever treated with ampicillin compared with those with clinical chorioamnionitis treated with ampicillin and gentamicin, the odds ratio of antibiotic treatment of endometritis was 2.65 (95% confidence interval, 1.06-6.62; P=.036), and the odds ratio of neonatal early-onset sepsis was 8.33 (95% confidence interval, 1.04-60.60; P=.045). Women with intrapartum fever, with or without other signs of infection, were at increased risk of maternal and neonatal complications. The use of ampicillin as a sole agent in isolated intrapartum fever might promote ampicillin-resistant E coli growth in the chorioamniotic membranes and consequently lead to puerperal endometritis and early-onset sepsis. In this context, a broad-range antibiotic should be considered.

Neonatal sepsis and its associated factors among neonates admitted to the neonatal intensive care unit in Wachemo University Comprehensive Specialized Hospital, Southern Ethiopia, 2022.

Neonatal sepsis is a major public health problem worldwide. It is one of the leading causes of neonatal mortality and morbidity worldwide. The neonatal mortality rate is higher in developing countries, where the extent and causes of neonatal sepsis are not yet known. Neonatal sepsis is a leading cause of neonatal mortality in Ethiopia. As a result, this study aimed to assess the proportion and identify maternal and neonatal risk factors for neonatal sepsis among neonates admitted to the neonatal intensive care unit. An institutional-based cross-sectional study was conducted from May 2022 to July 2022 at the Wachemo University Comprehensive Specialized Teaching Hospital, Neonatal Intensive Care Unit, southern Ethiopia. A total of 205 neonates with indexed mothers participated in the study. Using a consecutive sampling technique, a structured, pretested questionnaire was used to collect data from the study subjects. Data were entered into EpiData Manager version 3.1 for Windows and then exported to SPSS version 22 for further data cleaning and analysis. Descriptive analyses were performed by using frequency, percentage, and summary statistics to describe the key variables. A multivariate regression model was used to identify factors associated with neonatal sepsis. Finally, statistical significance was declared at a p-value of less than 0.05, and an adjusted odds ratio (AOR) with a 95% confidence level was used to declare the variable's association with the outcome variable. The overall prevalence rate of neonatal sepsis was 39.5% (95% CI: 33.7-45.9). Multivariable analysis was performed by taking a variable that is statistically significant in bivariate logistic regression as a candidate variable. Multivariable model analysis showed that unmarried status AOR = 18.37 (95% CI: 1.56-216.14), maternal fever during delivery AOR = 4.74 (95% CI: 1.63-13.8), and premature rupture of membrane AOR = 7.53 (95% CI: 2.19-25.6) were variables that increased the odds of developing neonatal sepsis. The study's findings indicate that neonatal sepsis is highly prevalent. Unmarried maternal status, maternal fever during delivery, and premature rupture of the membrane were predictors of neonatal sepsis. Therefore, providing training for health workers and close monitoring and evaluation during obstetric and neonatal care are crucial to halt the occurrence of neonatal sepsis.

Evaluation of two-dimensional ultrasound fetal thymus size in correlation to infection parameters in pregnancies complicated with preterm premature rupture of membranes

Background/aim The thymus is essential for developing the fetal immune system and may show involution upon exposure to acute stress. Early detection of intrauterine infection is urgently needed to avoid fetal affection and sepsis. The present study aims to correlate the fetal thymus size with the infection parameters in pregnancies complicated with preterm premature rupture of membranes (PPROM). Subjects and methods The present study recruited pregnant women who fulfilled the inclusion criteria in a ratio of 1 case to 4 controls according to the study design; Group 1 of twenty cases presenting in PPROM, and Group 2 of eighty cases of women without PPROM. The primary outcome of the study was to measure fetal thymus size by abdominal ultrasound and its correlation with maternal total leukocytic count (TLC) and its differential count, C-reactive protein (CRP), and maternal fever. The secondary outcomes involved the correlation of the fetal thymus size with fetal distress, the occurrence of neonatal infection, Apgar neonatal score, and histological examination of the placenta and membranes for evidence of chorioamnionitis. Results Group 1 had a significantly higher CRP level (P&lt;0.001), higher TLC level (P=0.035), and higher Staff (P&lt;0.001). On the contrary, group 2 had significantly higher AFI (P=0.022), greater Thymus perimeter (P&lt;0.001), and greater thymus transverse diameter (P&lt;0.001). In addition, the pathological examination of the placenta revealed positive signs of infection in group 1 in only 65% of cases. Group 1 had a positive correlation between Thymus perimeter and APGAR score of the neonates (r=0.658, P=0.002), Thymus perimeter and birth weight (r=0.741, P&lt;0.001), Thymus transverse diameter and APGAR score of the neonates (r=0.741, P&lt;0.001), and finally Thymus transverse diameter and birth weight (r=0.734, P&lt;0.001). Group 2 showed a significant positive correlation between the Thymus perimeter and neonatal APGAR score (r=0.232, P=0.039) and Thymus transverse diameter and birth weight (r=0.320, P=0.004). In Group 1, Cases with placental signs of infection (n=13) had higher CRP levels (P=0.046), higher TLC levels (P=0.014), higher Staff (P&lt;0.001), but lower AFI (P=0.032). Conclusion The assessment of the fetal thymus during the routine second- and/or third-trimester scan could be a predictive measure for intra-amniotic infection. However, there is no association between small fetal thymus and adverse perinatal outcomes in uncomplicated pregnancies. Further larger studies with different demographic, maternal characteristics, and different inflammatory processes with and without active management to summarize whether fetal thymus can be used in clinical practice to avoid infection-related fetal morbidities or not.

Paenibacillus spp infection among infants with postinfectious hydrocephalus in Uganda: an observational case-control study

Paenibacillus thiaminolyticus is a cause of postinfectious hydrocephalus among Ugandan infants. To determine whether Paenibacillus spp is a pathogen in neonatal sepsis, meningitis, and postinfectious hydrocephalus, we aimed to complete three separate studies of Ugandan infants. The first study was on peripartum prevalence of Paenibacillus in mother-newborn pairs. The second study assessed Paenibacillus in blood and cerebrospinal fluid (CSF) from neonates with sepsis. The third study assessed Paenibacillus in CSF from infants with hydrocephalus. In this observational study, we recruited mother-newborn pairs with and without maternal fever (mother-newborn cohort), neonates (aged ≤28 days) with sepsis (sepsis cohort), and infants (aged ≤90 days) with hydrocephalus with and without a history of neonatal sepsis and meningitis (hydrocephalus cohort) from three hospitals in Uganda between Jan 13, 2016 and Oct 2, 2019. We collected maternal blood, vaginal swabs, and placental samples and the cord from the mother-newborn pairs, and blood and CSF from neonates and infants. Bacterial content of infant CSF was characterised by 16S rDNA sequencing. We analysed all samples using quantitative PCR (qPCR) targeting either the Paenibacillus genus or Paenibacillus thiaminolyticus spp. We collected cranial ultrasound and computed tomography images in the subset of participants represented in more than one cohort. No Paenibacillus spp were detected in vaginal, maternal blood, placental, or cord blood specimens from the mother-newborn cohort by qPCR. Paenibacillus spp was detected in 6% (37 of 631 neonates) in the sepsis cohort and, of these, 14% (5 of 37 neonates) developed postinfectious hydrocephalus. Paenibacillus was the most enriched bacterial genera in postinfectious hydrocephalus CSF (91 [44%] of 209 patients) from the hydrocephalus cohort, with 16S showing 94% accuracy when validated by qPCR. Imaging showed progression from Paenibacillus spp-related meningitis to postinfectious hydrocephalus over 1-3 months. Patients with postinfectious hydrocephalus with Paenibacillus spp infections were geographically clustered. Paenibacillus spp causes neonatal sepsis and meningitis in Uganda and is the dominant cause of subsequent postinfectious hydrocephalus. There was no evidence of transplacental transmission, and geographical evidence was consistent with an environmental source of neonatal infection. Further work is needed to identify routes of infection and optimise treatment of neonatal Paenibacillus spp infection to lessen the burden of morbidity and mortality. National Institutes of Health and Boston Children's Hospital Office of Faculty Development.

Perinatal Risk Factors in Children Diagnosed with Autism Spectrum Disorder in Dubai: A Case-Control Study

Introduction: Autism spectrum disorder (ASD) is a heterogeneous disorder characterized by deficits in social-emotional reciprocity and associated behavioral symptoms. The goal of this study was to examine perinatal risk factors for ASD and their correlates in a tertiary care hospital in Dubai, United Arab Emirates (UAE). Methods: We conducted a case-control study of 87 children diagnosed with ASD using the DSM-5 criteria, who were born between 1999 and 2014, and diagnosed between 2014 and 2016, and 134 age- and gender-matched control subjects. Data were collected from hospital medical records. Associations between ASD and maternal, birth, and neonatal risk factors were examined using logistic regression analysis. Results: Maternal fever was associated with ASD (p = 0.018), with 0% in the control group and 5% in the cases. Multivariate logistic regression analysis revealed a trend for an association between high birthweight (>4,000 g) and ASD (95% CI: 0.76–59.93, p = 0.086). Conclusion: The data affirmed the established gender difference of approximately four males to one female and supported previous findings associating ASD with prematurity. Larger representative studies are further required to explore risk factors for ASD in the UAE.