What are the findings in fetuses and neonates with infection due to chorioamnionitis?

Updated: May 08, 2018
  • Author: Fayez M Bany-Mohammed, MD; Chief Editor: Ted Rosenkrantz, MD  more...
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Answer

The fetus may have tachycardia (>160 bpm) or decreased variability. [137]  A biophysical profile (BPP) performed on the fetus using ultrasonography may reveal a lower than normal score, but ultrasonic biophysical profile assessment has not been predictive of clinical chorioamnionitis. [138]  Lack of fetal breathing has been associated with fetal infection. [139, 140]

Tachypnea, respiratory distress (eg, expiratory grunt, retractions), cyanosis, pulmonary hemorrhage, and/or apnea (ie, pulmonary manifestations of pneumonia, sepsis, or both), must be immediately appreciated by caregivers. Nursery personnel must be aware that a neonate who is born without respiratory distress but who develops signs and symptoms of pulmonary disease in the first 6-12 hours of life has a heightened risk for congenital (infectious) pneumonia.

Tachycardia, hypotension, prolonged capillary refill time, cool and clammy skin, pale or mottled appearance, oliguria (ie, cardiovascular manifestations of sepsis), or a combination of these may be observed, typically occurring late in the course of early-onset sepsis (EOS). Caregivers must also consider other explanations for these physical findings, such as developmental defects in the cardiovascular system (ie, cardiovascular malformations with abnormalities of aortic blood flow) or inborn errors of metabolism.

Gastrointestinal symptoms, as outline above, may be nonspecific in patients with EOS.

Thermal regulatory abnormalities (ie, hypothermia or hyperthermia), behavioral abnormalities, apnea, seizures (ie, CNS manifestations), or a combination may be seen. A bulging fontanel or nuchal rigidity is not a reliable sign of meningitis in a neonate.

Pallor, petechiae or purpura, and overt bleeding (ie, hematopoietic involvement, liver involvement, or both) may be seen and requires immediate diagnostic and therapeutic attention.


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