Role of Guidelines on Length of Therapy in Chorioamnionitis and Neonatal Sepsis
Role of Guidelines on Length of Therapy in Chorioamnionitis and Neonatal Sepsis
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DOI：
10.1542/peds.2013-2927
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发表时间：
2014-06-01
期刊：
影响因子：
8
通讯作者：
Aghai, Zubair H.
中科院分区：
文献类型：
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作者：
Kiser, Courtney;Nawab, Ursula;Aghai, Zubair H.
背景与目的：绒毛膜炎（CAM）是新生儿败血症的主要危险因素。在我们的机构，暴露于CAM和产时抗生素的新生儿，如果实验室值异常，尽管无菌血培养，延长抗菌治疗。最近，胎儿和新生儿委员会（COFN）推荐了一种类似的策略来治疗接触CAM的新生儿。我们的目的是确定异常的实验室参数在长期和晚期早产儿接触CAM的频率和评估最近COFN guidelines.METHODS的含义：这一回顾性数据分析包括晚期早产儿和足月新生儿接触CAM。结果：共有554名婴儿符合纳入标准。83名婴儿（14.9%）在12小时龄时有异常的未成熟中性粒细胞与总中性粒细胞比率（>0.2），121名婴儿（22%）有异常的C反应蛋白水平（>1 mg/dL）。共有153名婴儿（27.6%）在12小时龄时有异常的未成熟中性粒细胞与总中性粒细胞比率和/或异常的C反应蛋白水平。554名婴儿中只有4名（0.7%）有阳性血培养结果。共有134名（24.2%）婴儿长期接受抗生素治疗（112名[20.2%]仅根据异常实验室数据进行治疗）。腰椎穿刺进行了120（21.6%）infants.CONCLUSIONS：当管理使用的策略类似于最近的COFN指南，大量的长期和晚期早产儿接触CAM谁有无菌血培养结果进行了长期的抗生素治疗，由于异常的实验室检查结果。他们还接受了额外的侵入性手术，住院时间更长。
BACKGROUND AND OBJECTIVE: Chorioamnionitis (CAM) is a major risk factor for neonatal sepsis. At our institution, neonates exposed to CAM and intrapartum antibiotics are treated with prolonged antimicrobial therapy if laboratory values are abnormal despite a sterile blood culture. Recently, the Committee on the Fetus and Newborn (COFN) recommended a similar strategy for treating neonates exposed to CAM. Our objective was to determine the frequency of abnormal laboratory parameters in term and late-preterm neonates exposed to CAM and evaluate the implication of recent COFN guidelines.METHODS: This retrospective data analysis included late-preterm and term neonates exposed to CAM. Laboratory parameters, clinical symptoms and the number of infants treated with prolonged antibiotics were determined.RESULTS: A total of 554 infants met the inclusion criteria. Eighty-three infants (14.9%) had an abnormal immature to total neutrophil ratio (>0.2) and 121 infants (22%) had an abnormal C-reactive protein level (>1 mg/dL) at 12 hours of age. A total of 153 infants (27.6%) had an abnormal immature to total neutrophil ratio and/or abnormal C-reactive protein level at 12 hours of age. Only 4 (0.7%) of 554 infants had a positive blood culture result. A total of 134 (24.2%) infants were treated with prolonged antibiotics (112 [20.2%] were treated solely based on abnormal laboratory data). Lumbar puncture was performed in 120 (21.6%) infants.CONCLUSIONS: When managed by using a strategy similar to recent COFN guidelines, a large number of term and late-preterm infants exposed to CAM who had sterile blood culture findings were treated with prolonged antibiotic therapy due to abnormal laboratory findings. They were also subjected to additional invasive procedures and had a longer duration of hospitalization.