Management of 168 Neonates Weighing More Than 2000 g Receiving Intrapartum Chemoprophylaxis for ChorioamnionitisEvaluation of an Early Discharge Strategy
Kamal K. Singhal, MD;
Edmund F. La Gamma, MD
Arch Pediatr Adolesc Med. 1996;150(2):158-163.
Abstract
| |
Objective
To determine whether sequential laboratory and clinical evaluations during the first 3 days of postnatal life can be used to safely limit the duration of antibiotic therapy for term neonates whose mothers received intrapartum antibiotic treatment for intra-amniotic infection (ie, chorioamnionitis).
Methods
Since postpartum neonatal body fluid cultures can be falsely negative because of transplacental passage of maternal antibiotics, we prospectively followed up 6620 pregnancies for 28 months (December 1991 through March 1994) for the occurrence and treatment of chorioamnionitis. Neonatal antibiotic therapy was initiated and limited to 3 days or continued for 7 days or more in neonates with abnormal laboratory values or clinical signs that were consistent with sepsis on day 3 of postnatal age. Both groups were observed in the hospital for 24 to 48 hours after antibiotics were discontinued.
Results
Of the 6620 pregnancies, 158 infants (2.4%) born to 155 mothers received intrapartum antibiotics for chorioamnionitis; 10 additional neonates diagnosed as having chorioamnionitis were transported from other hospitals (N=168). Because of the absence of signs and negative cultures, 82% (137/168) were treated with antibiotics for 3 days, while 18% (31/168) received 7 days or more of therapy. In 84% of the 3-day group, discharge was accomplished by postnatal day 4 or 5, whereas all of the 7-day or more group were discharged after day 8. Follow-up calls placed 1 month after discharge disclosed no adverse outcomes or hospital readmissions in any of the infants in this survey.
Conclusions
Neonates with infection who are born to mothers pretreated with antibiotics for intra-amniotic infection can be reliably identified less than 72 hours after birth and treated appropriately. As 82% of at-risk patients are asymptomatic and have a negative body fluid culture, our data support the position that a full course of antibiotic therapy can be restricted to only those patients with clinical or laboratory signs of sepsis (18%). This will effectively reduce the average length of hospital stay for intrapartum-treated neonates by a minimum of 3 to 4 days compared with a commonly used empiric therapy approach of continuing medication for 7 days or more. Perhaps hospital discharge can be further shortened if a 1- to 2-day posttreatment observation period is eliminated for all patients except those with a positive body fluid culture.
(Arch Pediatr Adolesc Med. 1996;150:158-163)
Author Affiliations
From the Division of Newborn Medicine, Department of Pediatrics, State University of New York at Stony Brook. Dr Singhal is now with the Division of Neonatology, Buffalo (NY) Children's Hospital.
 CiteULike  Connotea  Del.icio.us  Digg  Reddit  Technorati  Twitter
What's this?
THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES
Are Complete Blood Cell Counts Useful in the Evaluation of Asymptomatic Neonates Exposed to Suspected Chorioamnionitis?
Jackson et al.
Pediatrics 2004;113:1173-1180.
ABSTRACT
| FULL TEXT
Management of Asymptomatic Term Neonates Whose Mothers Received Intrapartum Antibiotics--Part 2: Diagnostic Tests and Management Strategies
Allen
CLIN PEDIATR 1997;36:617-624.
ABSTRACT
Management of Asymptomatic Term Neonates Whose Mothers Received Intrapartum Antibiotics Part-1: Rationale for ltrapartum Antibiotic Therapy
Allen
CLIN PEDIATR 1997;36:563-568.
ABSTRACT
ANTEPARTUM ANTIBIOTICS FOR CHORIOAMNIONITIS: HOW TO MANAGE THE NEWBORN?
JWatch General 1996;1996:7-7.
FULL TEXT
|
