University of Michigan
Department of Pediatrics
Evidence-Based Pediatrics Web Site

Question

• Do asymptomatic full-term infants born to mothers treated for chorioamnionitis require complete sepsis work-ups and antibiotics?

Clinical Bottom Lines

1. The outcome of full-term (FT), asymptomatic neonates born to mothers who receive intrapartum antibiotic treatment for chorioamnionitis has not been adequately investigated to alter current management.
2. Sepsis incidence among FT infants born to mothers treated for chorioamnionitis is greater than the overall baseline neonatal sepsis incidence, regardless of initial presentation (symptomatic vs asymptomatic).
3. Current conservative evaluation and treatment of these infants cannot be abandoned given current evidence.

Summary of Key Evidence

1. Asymptomatic, full-term infants of mothers treated for chorioamnionitis had positive blood cultures 1.5% of the time.¹
2. Symptomatic, full term infants of mothers treated for chorioamnionitis had positive blood cultures 13% of the time (p >0.05).¹
   
3. Baseline risk of positive blood cultures in full-term infants is ~0.08%.²
4. Intrapartum antibiotics decrease sepsis incidence in full-term infants born to mothers with chorioamnionitis.³
5. No studies directly compare outcomes of FT infants born to mothers treated for chorioamnionitis to "normal newborns."
6. The difference in bacteremia incidences for symptomatic and asymptomatic infants born to mothers treated for choirioamnionitis was not statistically significant.
7. Further studies needed to justify altering practice guidelines.
   

Additional Comments

• Literature evaluation reveals greater sepsis risk for study group than for all newborns (baseline risk).^1,2
• Altering practice guidelines would result in missing infants with bacteremia and partially treated sepsis, which could produce serious morbidity and/or additional mortality.
• Study performed in 1993, before guidelines for GBS screening and treatment implemented. Etiology of early-onset neonatal sepsis has changed since study published.⁴
• A more recent cohort study is needed to ascertain current sepsis incidence and etiology before current conservative approach to infants born to mothers with chorioamnionitis can be altered.
  

Citation

1. Mecredy RL, Wiswell TE. Hume RF. Outcome of term gestation neonates whose mothers received intrapartum antibiotics for suspected chorioamnionitis. Am J Perinatology 1993; 10:365-8.
2. Karpuch J, Goldberg M, Kohelet D. Neonatal bacteremia. A 4-year prospective study. Isr J Med Sci 1983; 19:963-6.
3. Gilstrap L, et al. Intrapartum treatment of acute chorioamnionitis: Impact on neonatal sepsis. Am J Obstetrics Gynec 1988;159:579-83.
4. Neonatal sepsis: Intraamniotic infection. Up-To-Date. 2004.

CAT Author: Lisa Shea Allred, MD

CAT Appraisers: Kenneth Pituch, MD

Date appraised: November 10, 2004