What are hospitalization and discharge considerations for neonates exposed to chorioamnionitis?

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

When the newborn exposed to chorioamnionitis is preterm (4</ref> [77, 202, 203, 204]

One approach to limiting the unnecessary use of antimicrobials is to use the “sepsis calculator” developed by Puopolo et al [205] to estimate the probability of early-onset sepsis (EOS) using maternal risk factors in neonates born at 34 weeks of gestation or Later. Utilizing data from more than 600,000 infants at at least 34 weeks’ gestation at birth, the investigators developed a model for EOS risk prediction based on objective maternal factors, then combined that model with findings from examination of the infants. [206] The model uses three categorical variables: group B Streptococcus (GBS) status (positive, negative, uncertain), maternal intrapartum antimicrobial treatment (GBS-specific or broad spectrum), and intrapartum prophylaxis or treatment given 4 hours or longer before delivery (yes, no) in addition to the following continuous variables: highest maternal intrapartum temperature (centigrade or Fahrenheit), gestational age (weeks and days), and duration of rupture of membranes (hours). A predicted probability per 1,000 live births can be estimated using the calculator (http://newbornsepsiscalculator.org). Several retrospective studies demonstrated that the use of the sepsis calculator in a population of well-appearing neonates (≥34 weeks' gestation) exposed to the clinical maternal diagnosis of chorioamnionitis would have substantially reduced the proportion of neonates undergoing laboratory tests and receiving antimicrobial agents. [202, 207, 208, 209]

Term neonates undergoing an evaluation to exclude sepsis who consistently appear well can probably go home with their mothers within 48 hours after birth. Septic-appearing neonates usually receive antibiotic therapy via the parenteral route until treatment is deemed complete and the infant is well. Depending on the nature of the infection and other risk factors associated with the hospitalization (eg, extreme prematurity, need for home oxygen), an outpatient follow-up visit may be scheduled from 1 day to 2 weeks after discharge. Home healthcare follow-up visits by a reliable and well-trained nursing service may also be indicated.


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