Study in Pediatrics: Chorioamnionitis and Management of Asymptomatic Infants ≥35 Weeks Without Empiric Antibiotics

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BACKGROUND AND OBJECTIVE: Management of asymptomatic infants ≥35 weeks’ gestation born to mothers with chorioamnionitis remains controversial, with many clinicians considering the need for changes to the current guidelines. The study objective was to evaluate the outcomes of asymptomatic chorioamnionitis-exposed neonates without the use of immediate empirical antibiotics.

METHODS: A retrospective data review was conducted from May 2008 to December 2014, including asymptomatic infants ≥35 weeks’ gestation with a maternal diagnosis of clinical chorioamnionitis.

RESULTS: A total of 240 asymptomatic infants with chorioamnionitis exposure were identified. The majority of asymptomatic chorioamnionitis-exposed infants, 162 (67.5%), remained well in the mother-infant unit with a median stay of 2 days. There were 78 (32.5%) infants admitted to the NICU and exposed to antibiotics due to abnormal laboratory data or development of clinical symptoms. Of those infants admitted to the NICU, 19 (24%) received antibiotics for <72 hours, 47 (60%) were treated for culture-negative clinical sepsis, and 12 (15%) for culture-positive sepsis, with a median NICU stay of 7 days.

CONCLUSIONS: Nonroutine use of empirical antibiotics in asymptomatic newborns ≥35 weeks’ gestation with maternal chorioamnionitis prevented NICU admission in two-thirds of these infants. This prevented unnecessary antibiotic exposure, increased hospitalization costs, and disruption of mother-infant bonding and breastfeeding. Laboratory evaluation and clinical observation without immediate antibiotic administration may be incorporated into a management approach in asymptomatic chorioamnionitis-exposed neonates. Additional studies are needed to establish the safety of this approach.

Reference: Amanda I. Jan, Rangasamy Ramanathan, Rowena G. Cayabyab. Chorioamnionitis and Management of Asymptomatic Infants ≥35 Weeks Without Empiric Antibiotics. Pediatrics. Jul 2017, 140 (1) e20162744; DOI: 10.1542/peds.2016-2744