Maternal Fever Research Articles

Evaluating the Impact of the 2017 Dutch Neonatal Early-Onset Sepsis Guideline.

In 2017, a new Dutch neonatal early-onset sepsis (EOS) guideline was implemented. It is an adaptation from the United Kingdom National Institute for Health and Care Excellence guideline and focuses on maternal and neonatal risk factors. We aim to assess if this guideline performs better at reducing the rate of antibiotic treatment for EOS than the old Dutch categorical EOS guideline, which focused primarily on group B streptococcus (GBS) testing and prophylaxis. We performed a single-center retrospective cohort study in the Netherlands. Data were collected from two 12-month epochs (2015 vs. 2019). Neonates were included when treated for suspected EOS or when observed for an elevated EOS risk. The empirical antibiotic rate was 4.6% in both years. Prolonged antibiotic treatment (>48 u) increased from 24% in 2015 to 39% in 2019 ( P = 0.021). Adherence to the guideline decreased from 98% in 2015 to 84% in 2019 ( P < 0.001). Strict adherence in 2019 would have led to more antibiotic treatment (5.1% instead of 4.6%). The EOS incidence rate was comparable, namely 0.6% in 2015 and 0.0% in 2019 ( P = 0.480). The change in the definition of risk factors in 2019 led to less antibiotic treatment in case of a maternal fever during birth, from 48% in 2015 to 26% in 2019 ( P < 0.001). The new Dutch categorical EOS guideline does not achieve its intended purpose of reducing empiric antibiotic therapy for suspected EOS. We advocate the need for a new screening strategy.

C.3 Development and validation of a prediction model for perinatal arterial ischemic stroke in term neonates

Background: Perinatal arterial ischemic stroke (PAIS) is a focal brain injury in term neonates, identified postnatally but presumed to occur around birth. Early risk detection and targeted treatments are limited. We developed and validated a diagnostic risk prediction model from common clinical factors to predict a term neonate’s probability of PAIS. Methods: A diagnostic prediction model was developed using multivariable logistic regression. Common pregnancy, delivery, and neonatal clinical factors were collected across four registries. Variable selection was based on peer-reviewed literature. Participant inclusion criteria were term birth and no underlying predisposition to stroke. The primary outcome was discriminative accuracy of the model predicting PAIS, measured by the concordance (C-) statistic. Results: 2571 participants (527 cases, 2044 controls) were eligible for analysis. Nine variables were included in the model – maternal age, tobacco exposure, recreational drug exposure, pre-eclampsia, chorioamnionitis, maternal fever, emergency c-section, low 5-minute Apgar score, and sex – to predict the risk of PAIS in a term neonate. This model demonstrated good discrimination between cases and controls (C-statistic 0.73) and model fit (Hosmer-Lemeshow p=0.20). Conclusions: Clinical variables can be used to develop and internally validate a model of PAIS risk prediction. Identifying high-risk neonates for early screening and treatment could reduce lifelong morbidity.

Maternal Fever Associated With Continuous Spinal Versus Epidural Labor Analgesia: A Single-Center Retrospective Study

(Anesth Analg. 2022;135:1153–1158) Neuraxial labor analgesia commonly results in maternal fevers, though the cause is unknown. Possible causes include infection, inflammation, and altered thermoregulation. An alternative pain management to epidural labor is continuous spinal analgesia, which has lower neuraxial and systemic bupivacaine levels and may decrease the rate of maternal fever. No studies to date have compared maternal fever rates between epidural labor and continuous spinal analgesia. The aim of this study is to compare 2 techniques and better understand the mechanism that drives maternal fevers in association with epidural labor analgesia.

Severity of Intrapartum Fever and Neonatal Outcomes

(Am J Obstet Gynecol. 2022;227:513.e1–513.e8) Infection- or noninfection-mediated intrapartum maternal fever (≥38 °C) is a frequent complication of childbirth, affecting 1 in 15 deliveries. Associations with increased risk for neonatal morbidity include low Apgar score, sepsis, encephalopathy, seizures, respiratory distress, meconium aspiration, and NICU admission. Risk for maternal morbidity as defined by labor dystocia, hemorrhage, instrumental vaginal delivery, and cesarean delivery is also heightened. Studies investigating the correlation of fever severity to increased neonatal and maternal morbidity are conflicting and have been conducted in homogenous patient populations with labor management differing from the standard of care in the United States. The aim of this study was to evaluate the relationship between increased severity of intrapartum fever and maternal and neonatal morbidity in a diverse, contemporary cohort, and medical practice. The authors hypothesized that risk would be independent from the duration of the time from the maximum fever temperature (Tmax) through to delivery.

Antenatal corticosteroids reduce neonatal mortality in settings without assisted ventilatory support: a retrospective cohort study of early preterm births on the Thailand-Myanmar border

Background: Prematurity is the highest risk for under-five mortality globally. The aim of the study was to assess the effect of antenatal dexamethasone on neonatal mortality in early preterm in a resource-constrained setting without assisted ventilation. Methods: This retrospective (2008-2013) cohort study in clinics for refugees/migrants on the Thai-Myanmar border included infants born &lt;34 weeks gestation at home, in, or on the way to the clinic. Dexamethasone, 24 mg (three 8 mg intramuscular doses, every 8 hours), was prescribed to women at risk of preterm birth (28 to &lt;34 weeks). Appropriate newborn care was available: including oxygen but not assisted ventilation. Mortality and maternal fever were compared by number of doses (complete: three, incomplete: one or two, or no dose). A sub-cohort participated to neurodevelopmental testing at one year. Results: Of 15,285 singleton births, 240 were included: 96 did not receive dexamethasone and 144 received one, two or three doses (56, 13 and 75, respectively). Of live born infants (n=233), early neonatal and neonatal mortality/ 1,000 livebirths (95%CI) with complete dosing was 141 (78–240) and 304 (191–448); compared to 292 (210–389) and 521 (407–633) with no dose. Compared to complete dosing, both incomplete and no dexamethasone were associated with elevated adjusted ORs 4.09 (1.39 to 12.00) and 3.13 (1.14 to 8.63), for early neonatal death. By contrast, for neonatal death, while there was clear evidence that no dosing was associated with higher mortality, adjusted OR 3.82 (1.42 to 10.27), the benefit of incomplete dosing was uncertain adjusted OR 1.75 (0.63 to 4.81). No adverse impact of dexamethasone on maternal fever or neurodevelopmental scores was observed. Conclusions: Neonatal mortality reduction is possible with complete dexamethasone dosing in pregnancies at risk of preterm birth in settings without capacity to provide assisted ventilation.

Intrapartum Maternal Fever and Long-Term Infectious Morbidity of the Offspring.

Maternal intrapartum fever can lead to various maternal and neonatal complications and is attributed to various etiologies including infectious and non-infectious processes. In this study, we evaluated whether intrapartum fever affects the offspring's tendency to long-term infectious morbidity. A population-based cohort analysis including deliveries between 1991 and 2021 was conducted. The incidence of hospitalizations of the offspring up to the age of 18 years, due to various infectious conditions, was compared between pregnancies complicated by intrapartum fever and those that were not. A Kaplan-Meier survival curve was used to assess cumulative hospitalization incidence. A Cox proportional hazards model was used to control for confounders. Overall, 538 of the 356,356 included pregnancies were complicated with fever. A higher rate of pediatric hospitalizations due to various infectious conditions was found among the exposed group, which was significant for viral, fungal and ENT infections (p < 0.05 for all). The total number of infectious-related hospitalizations was significantly higher (30.1% vs. 24.1%; OR = 1.36; p = 0.001), as was the cumulative incidence of hospitalizations. This association remained significant after controlling for confounders using a Cox proportional hazards model (adjusted HR = 1.21; 95% CI 1.04-1.41, p = 0.016). To conclude, fever diagnosed close to delivery may influence offspring susceptibility to pediatric infections.

Maternal and Placental Risk Factors for Small Gestational Age and Fetal Malnutrition.

This case-control study was conducted to identify maternal and placental risk factors of small-for-gestational-age (SGA) and fetal malnutrition. Cases comprised 104 consecutively delivered SGA neonates (determined as per INTERGROWTH- 21st standard). An equal number of next-born gestation and gender-matched appropriatefor- gestational age (AGA) neonates served as controls. Maternal risk factors were enquired, and placentae were evaluated by clinical and histopathological examination. Nutrition of the neonates was assessed by the clinical assessment of nutrition (CAN) score. Univariate and multivariate logistic regression analysis was done to identify the maternal and placental risk factors. The prevalence of SGA in the present study was 23.9%. Maternal fever [adjusted Odds Ratio (aOR), 95% confidence interval (CI), 16.3 (3.5-124.1); p = 0.001], presence of placental syncytial knots [aOR (95% CI), 2.9 (1.1-9.1); p = 0.04] and placental calcifications [aOR (95% CI), 3(1.1- 8.7); p = 0.03], were identified as independent predictors of SGA using multivariate logistic regression analysis. Malnutrition (SCORE <25) affected 64% of SGA and 16.3% of AGA neonates. The only risk factor significantly associated with malnourished SGA was prematurity, whereas malnourished AGA was significantly associated with prematurity and fetal distress. In-hospital morbidities significantly higher in SGA were perinatal asphyxia, respiratory distress, need for respiratory support, polycythemia, hypoglycemia, and feeding intolerance. Mortality before discharge was 4.8% and 3.8% in SGA and AGA population, respectively (p > 0.05). Neonatal outcomes were comparable among well-nourished, malnourished SGA and AGA groups. Maternal fever, placental syncytial knots, and calcifications were independent risk factors of SGA, whereas prematurity and fetal distress were responsible for malnutrition.

Perinatal outcomes and risk factors for epidural analgesia-associated intrapartum maternal fever: a retrospective study

Background Epidural analgesia (EA) increases the risks of maternal fever during labor, which is associated with adverse maternal and neonatal outcomes, while the risk factors for epidural-associated fever and strategies for minimizing these effects remain limited. Methods A total of 325 pregnant women were retrospectively analyzed who had attended our hospital for a vaginal in-hospital delivery, including 208 who voluntarily accepted EA and 117 who did not receive EA. During labor, 208 EA women were allocated to a fever group (n = 42, a tympanic temperature ≥37.5 °C during labor), and a no fever group (n = 166). The outcome measures included main maternal and neonatal outcomes, labor times, duration of EA and the total EA dosage administered. Results 42 out of 208 women given EA exhibited fever temperatures during labor, which were higher than in women who did not receive EA (20.19% vs. 0.85%). Maternal fever had an increased risks for conversion to surgery (adjusted odds ratio (AOR), 4.05; 95% CI, 1.44–11.39) and neonatal infections (5.13; 1.98–13.29) compared to the no fever group. While maternal fever did not increase the risks for assisted vaginal delivery, fetal distress or admission to the neonatal intensive care unit (NICU), it was predominantly associated with primiparity and lesser times of gravity. Frequent cervical examinations, the duration of first stage and total labor, and the duration of EA and its total dosage were positively correlated with the incidence of fever. Furthermore, after stratifying risk factors into subgroups, we found that more frequent cervical examinations (≥7 times) and longer duration of first stage (≥442.5 min), total labor time (≥490 min), EA (≥610.0 min) increased the risk for epidural-associated fever after adjustment for potential confounding factors. Conclusions EA increased the risk of intrapartum epidural-associated fever, which was correlated with adverse perinatal outcomes. Nulliparity, less times of gravidity, ≥7 cervical examinations, increased volume of the EA dosage, prolonged duration of EA and total labor time were risk factors for epidural-associated fever. The findings provide clinicians with insights and strategies to prevent epidural-associated fever more safely and effectively.

Diagnosing early-onset neonatal sepsis in low-resource settings: development of a multivariable prediction model

ObjectiveTo develop a clinical prediction model to diagnose neonatal sepsis in low-resource settings.DesignSecondary analysis of data collected by the Neotree digital health system from 1 February 2019 to 31 March...

Prevalence of acute kidney injury and its characteristics among neonates with suspected sepsis in a tertiary hospital in Kenya.

Unique aspects of neonatal renal physiology enhance the occurrence of Acute Kidney Injury (AKI) as a complication of neonatal sepsis. The study sought to determine prevalence of AKI and its characteristics in neonates with suspected sepsis. A cross-sectional study was conducted at Kenyatta National Hospital among neonates aged 0-28 days. AKI was defined as serum creatinine of more than 100µmmol/l. Among 332 neonates included 120 had AKI giving a prevalence of 36.1% (95% CI 31 to 41.6). Based on RIFLE criteria the commonest AKI presentation was Failure 72 (62.6%, 95% CI 53.6 to 71.6), followed by Injury 26 (22.6%, 95% CI 14.8 to 30.4) and then Risk 17 (14.8%, 95% CI 8.2 to 21.3). AKI was more common in neonates with suspected late onset sepsis (p=0.004). Maternal fever in the preceding week to delivery and presence of either puerperal sepsis or post-partum hemorrhage were significantly associated with severe AKI (p=0.004 and p=0.038). Prevalence of AKI was high; those with suspected late onset sepsis were more likely to develop AKI compared to early onset sepsis. Presence of maternal fever preceding delivery and presence of either puerperal sepsis or postpartum hemorrhage were associated with severe forms of AKI.

Identification of Preventable Risk Factors for Developmental Delay in Children: A Pilot Study

Purpose: Developmental delay (DD) is reported to be frequent in developing countries, such as India. Hence, this study was carried out to evaluate preventable risk factors that can predispose children to DD, through observations of pediatric neurology outpatients. Methods: This was a prospective, observational, and descriptive cross-sectional single-center hospital-based study for a period of 30 days, split into two separate time periods due to the impact of the coronavirus disease 2019 pandemic. Children who newly presented to the pediatric neurology outpatient department were considered. There were a total of 151 boys and girls, from 6 months to 14 years of age. Detailed demographic information on prenatal, natal and postnatal risk factors relevant to the neurological diagnosis was collected. Antenatal education for mothers about breastfeeding and newborn care, place of delivery, the availability of round-the-clock pediatric care during the delivery, gestational age, maternal fever, encephalitis, seizures, meningitis, blood pressure, gestational diabetes mellitus, infections, history of consanguinity, and genetic disorders were all considered. The data were analyzed with odds ratios and multivariable logistic regression. Results: Forty-three of the 151 enrolled children had DD. Significant associations were found between consanguinity and DD (adjusted odds ratio [AOR], 6.50; 95% confidence interval [CI], 1.96 to 21.51; P&lt;0.002) and between prematurity and DD (AOR, 2.34; 95% CI, 1.07 to 5.13; P&lt;0.033). Conclusion: This study shows that consanguineous marriages and prematurity predisposed children to DD when prenatal, natal, and postnatal risk factors were comprehensively considered.

Neonatal Group B Streptococcal Infection in Australia: A Case-control Study.

To determine maternal and neonatal risk factors for, and incidence of, neonatal early-onset group B streptococcus (EOGBS) and late-onset (LOGBS) infection in South Australia (SA) and the Northern Territory (NT). A case-control study with 2:1 matched controls to cases. The study included tertiary hospitals in South Australia and the Northern Territory, Australia. Retrospective data were collected from a 16-year epoch (2000-2015). Of a total of 188 clinically suspected or confirmed cases, 139 were confirmed, of which 56.1% (n = 78) were EOGBS and 43.9% (n = 61) were LOGBS. The incidence of clinically suspected and confirmed cases of EOGBS was 0.26/1000 live births in SA and 0.73/1000 live births in the NT, and the incidence of confirmed cases was 0.19/1000 for SA and 0.36/1000 for the NT. The incidence of clinically suspected or confirmed LOGBS was 0.18/1000 live births in SA and 0.16/1000 for the NT. The majority of infants with GBS presented with sepsis, pneumonia, or meningitis. Developmental delay was the most commonly recorded long-term complication at 1 year old. Risk factors for EOGBS included maternal GBS carriage, previous fetal death, identifying as Aboriginal and/or Torres Strait Islander, and maternal fever in labor/chorioamnionitis. GBS remains a leading cause of neonatal morbidity and mortality. Adding previous fetal death to GBS screening guidelines would improve GBS prevention. The introduction of maternal GBS vaccination programs should be guided by country-specific disease epidemiology.

Successful pregnancy of a patient with primary sclerosing cholangitis awaiting liver transplantation

In women, primary sclerotising cholangitis (PSC) associated with ulcerative colitis and intrahepatic cholestasis is a rare disease. To date, there are no data from Hungary on the fertility and pregnancy outcome of women with this chronic liver disease. Our aim is to present the favorable pregnancy outcome of a woman with PSC associated with ulcerative colitis, intrahepatic cholestasis and postpartum colectomy, and review of the literature. A young nulligravida was first diagnosed with ulcerative colitis. Five years later, PSC developed with progressive fibrosis and cholestasis necessitating liver transplantation. While on waiting list, spontaneous conception occurred. Except for pregnancy-induced hypertension, pregnancy uneventfully progressed until the third trimester when 8 g oral cholestyramine/day was administered to lower high maternal (over 100 μmol/L) total bile acid (TBA) level. In the 36th week of gestation acute exacerbation of ulcerative colitis resulted in maternal fever and chorioamnionitis leading to fetal distress. Elective delivery of the eutrophic neonate followed by emergency cesarean section. In the early puerperium, colitis progressed to septic pancolitis resistant to medical treatment. 12 days after laparoscopic subtotal colectomy, the patient was discharged in good health condition. 3 months later, ileostomy was closed and she got back on the transplantation waiting list. Our data correspond with previous reports and suggest that women with PSC with underlying ulcerative colitis and cholestasis have a good chance for favorable pregnancy outcome. However, both PSC and underlying colitis might progress during pregnancy and puerperium. Oral cholestyramin is an effective and safe treatment for high maternal TBA levels. Orv Hetil. 2023; 164(6): 234-240.

Risk Factors Associated with Early Onset of Sepsis

Background: Neonatal sepsis (EOS) is among one of the leading cause of death that usually occurs due to infection in the first month of life and can be the result of various maternal and neonatal contributing factors. Objectives: To determine maternal and neonatal contributing factors for early onset of sepsis in neonates. Study design: cross sectional study Period: From 13th April 2019 to 12th Oct 2019. Settings: Neonatal units of pediatric medicine of central park teaching hospital Lahore and Bhatti international hospital Kasur. Material and methods: After approval from hospital ethical committee total 151 neonates were selected using non-probable consecutive sampling. Neonates of both gender who were having gestational age &gt;30 weeks with early onset sepsis were enrolled. Patients who had received antibiotics before presentation were excluded. 5ml of venous blood after proper sterilization was taken from all patients and sent to hospital laboratory for WBC count, CRP and blood culture. Data was entered in pre-designed Performa and analyzed using SPSS 20. Results: There were total 151 patients in study, minimum and maximum age was 1 day and 7 days respectively with mean age of 3.66±1.88 days. Mean gestational age was 35.5±2.6 weeks and mean birth weight was 2.2±1.4 kg. There was slight increase in female patients 51% and 49% males. Among maternal contributing factors maternal fever was found in 64.9%, premature rupture of membrane was found in 43%, foul smelling liquor in 37.1% and meconium-stained amniotic fluid was found in 33.1% neonates. Among neonatal contributing factors prematurity was found in 66.2% low birth weight was present in 64.2%, and low APGAR score was present in 56.6 % neonates. Data was stratified for gender and contributing risk factors but p value was not statistically significant. Data was stratified for gestational age and p value was significant for prematurity, low birth weight and offensive smelling liquor. Conclusion: Prematurity, low birth weight, low APGAR score and maternal fever were significant contributing factors in EOS. Keywords: EOS, Neonatal contributing factors, Maternal contributing factors

A study of risk factors and clinical characteristics of neonatal pneumonia in a tertiary care centre

Background: Neonatal pneumonia accounts for significant morbidity and mortality, especially in developing countries. Throughout childhood, the greatest risk of death from pneumonia is in the neonatal period. This study is done to study the risk factors and clinical characteristics of neonatal pneumonia. Aim of the study was to study the risk factors and clinical characteristics of neonatal pneumonia. Methods: This was a hospital-based observational study conducted in the department of paediatrics, Gandhi medical college and hospital, Hyderabad. A detailed antenatal and postnatal risk factors were taken, and the clinical signs and symptoms of neonatal pneumonia were noted. Results: Of the 100 neonates 30% of cases had early onset pneumonia and 70% had late onset pneumonia.50% of early onset pneumonia cases had antenatal risk factors. There is a statistically significant association of age of onset of pneumonia with gestational age (p=0.002) late onset pneumonia being more common &gt;37 weeks of gestational age. 80% of early onset pneumonia cases were associated with septicaemia. Conclusions: Pneumonia is one of the most common causes of respiratory distress in neonates. Late onset pneumonia was more common. Major predisposing factors for early onset pneumonia are antenatal risk factors like premature rupture of membranes, maternal fever, major predisposing factors for late onset pneumonia are pre-lacteals, oil instillation in the nose, and aspiration of milk. Cough as a symptom was observed in late onset pneumonia.

Association between epidural-related maternal fever and short-and long-term prognosis of parturients: A prospective observational study.

We aimed to explore the association between epidural-related maternal fever (ERMF) and prognosis of parturients. 159 parturients who underwent vaginal delivery under labor epidural analgesia (LEA) received noninvasive continuous core body temperature monitoring. 122 of them completed the 42-day postpartum follow-up. Parturients with body temperature ≥38°C during labor were categorized as the Fever group, while the others were categorized as the No-Fever group. Compared to No-Fever group, Fever group had a greater proportion of primiparas, greater gestational age of parturients, and longer third stage of labor. The cesarean section and forceps delivery rates, and the amount of intrapartum hemorrhage in Fever group were significantly higher. There were no significant between-group differences with respect to puerperal infection, and amniotic fluid turbidity degree, neither significant between-group difference at 42-days postpartum. We found that ERMF was associated with some short-term outcomes. However, it showed no relation with long-term prognosis of the parturients at 42-days postpartum.

Neuromotor repertoires in infants exposed to maternal COVID-19 during pregnancy: a cohort study

ObjectiveTo evaluate neuromotor repertoires and developmental milestones in infants exposed to antenatal COVID-19.DesignLongitudinal cohort study.SettingHospital-based study in Los Angeles, USA and Rio de Janeiro, Brazil between March 2020 and December...

The effects of patient-controlled analgesia (maternal fever, interleukin 6 and interleukin 8) applied intravenously and epidurally in labor analgesia

The aim of this study was to compare maternal fever, interleukin-6 (IL-6), and interleukin-8 (IL-8) levels among women who were administered either epidural or intravenous labor analgesia. The study included 30 pregnant women who had applied to the Gynecology &amp; Obstetrics Clinics of Antalya Training and Research Hospital to have normal delivery. Patients were randomized to receive either epidural (Group I) or intravenous (Group II) analgesia. In both groups before analgesia and after the termination of labor, 5 ml blood was taken into yellow-cap gel tubes, which were centrifuged at 4100 rpm for 10 minutes. Sera were stored in 1-ml Eppendorf tubes at -800C. Serum IL-6 and IL-8 levels were measured with Human IL-6-PicoKine ELISA kit with a control vial and Human IL-8-PicoKine ELISA. The temperature was followed throughout the labor period. No patient in either group had a temperature above 380C during the labor period. Both groups showed significant increases in post-delivery IL-6 levels compared to pre-delivery levels (p&lt;0.05). Post-delivery IL-8 levels were also raised in both groups, albeit statistically significant merely in Group II (p&lt;0.05). Pre-delivery IL-6 level in Group 1 was significantly higher than that of Group II (p&lt;0.05). Group I and Group II did not differ in terms of post-delivery IL-6 levels (p&gt;0.05). Both the pre-delivery and post-delivery IL-8 level of Group I was significantly elevated compared with those of Group II (p&lt;0.05). The difference between pre-and post-delivery IL-6 and IL-8 levels of both groups was found to be similar (p&gt;0.05). While more markedly in epidural analgesia group, IL-6 and IL-8, which were among the cytokines released during normal delivery, exhibited elevations in pregnant women who were administered either epidural or intravenous analgesia. It implies no alteration to occur in cellular immune response by the analgesia method used in normal delivery.

Prediction of intrapartum fever using continuously monitored vital signs and heart rate variability.

Neonatal early onset sepsis (EOS), bacterial infection during the first seven days of life, is difficult to diagnose because presenting signs are non-specific, but early diagnosis before birth can direct life-saving treatment for mother and baby. Specifically, maternal fever during labor from placental infection is the strongest predictor of EOS. Alterations in maternal heart rate variability (HRV) may precede development of intrapartum fever, enabling incipient EOS detection. The objective of this work was to build a predictive model for intrapartum fever. Continuously measured temperature, heart rate, and beat-to-beat RR intervals were obtained from wireless sensors on women (n = 141) in labor; traditional manual vital signs were taken every 3-6 hours. Validated measures of HRV were calculated in moving 5-minute windows of RR intervals: standard deviation of normal-to-normal intervals (SDNN) and root mean square of successive differences (RMSSD) between normal heartbeats. Fever (>38.0 °C) was detected by manual or continuous measurements in 48 women. Compared to afebrile mothers, average SDNN and RMSSD in febrile mothers decreased significantly (p < 0.001) at 2 and 3 hours before fever onset, respectively. This observed HRV divergence and raw recorded vitals were applied to a logistic regression model at various time horizons, up to 4-5 hours before fever onset. Model performance increased with decreasing time horizons, and a model built using continuous vital signs as input variables consistently outperformed a model built from episodic vital signs. HRV-based predictive models could identify mothers at risk for fever and infants at risk for EOS, guiding maternal antibiotic prophylaxis and neonatal monitoring.

Effect of Maternal Familial Mediterranean Fever on Fetal Pulmonary Artery Acceleration/Ejection Time

Effect of Maternal Familial Mediterranean Fever on Fetal Pulmonary Artery Acceleration/Ejection Time