What is the role of chorioamnionitis in the etiology of neonatal sepsis?

Updated: Jun 13, 2019
  • Author: Nathan S Gollehon, MD, FAAP; Chief Editor: Muhammad Aslam, MD  more...
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Answer

The relationship between chorioamnionitis and other risk variables is strong. Suspect chorioamnionitis in the presence of fetal tachycardia, uterine tenderness, purulent amniotic fluid, an elevated maternal white blood cell (WBC) count, and an unexplained maternal temperature higher than 38°C (100.4°F).

The diagnosis of chorioamnionitis has been a trigger point for sepsis evaluation and initiation of empiric antibiotics based on guidelines from the Centers for Disease Control and Prevention (CDC), [25] American College of Obstetricians and Gynecologists (ACOG), [24, 32]  and American Academy of Pediatrics (AAP). [22] This approach has been criticized based upon the low incidence of culture-positive early-onset sepsis and the growing evidence of deleterious effects from unnecessary antibiotic exposure. In 2015, a panel of experts recommended that the term “chorioamnionitis” be replaced with “intrauterine inflammation or infection or both” (triple I), emphasizing that isolated maternal fever does not automatically equate to chorioamnionitis. [33]

A newer approach to this issue has used a multivariate predictive model that takes into account maternal GBS status, appropriateness of intrapartum GBS coverage, gestational age, duration of rupture of membranes, highest intrapartum maternal temperature, along with the neonate’s examination following birth.  This model, commonly referred to as the “Kaiser Sepsis Calculator” has allowed for a dramatic reduction in the use of empiric antibiotics (from 5.0% of all births before implementation to 2.8% of all births afterward) and obtaining blood cultures (12.8% of all births before implementation to < 5% of all births afterward), without an increase in the rate of morbidity or mortality or readmissions for early-onset sepsis. [34, 35]


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