Management of 168 neonates weighing more than 2000 g receiving intrapartum chemoprophylaxis for chorioamnionitis. Evaluation of an early discharge strategy
K. K. Singhal and E. F. La Gamma
Department of Pediatrics, State University of New York at Stony Brook, USA.
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 effective 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.
