Shakib Julie, Buchi Karen, Smith Elizabeth, Young Paul C
Department of Pediatrics, University of Utah, Salt Lake City, UT.
Department of Pediatrics, University of Utah, Salt Lake City, UT.
Acad Pediatr. 2015 May-Jun;15(3):340-4. doi: 10.1016/j.acap.2014.11.007.
Current recommendations are that newborns of mothers with chorioamnionitis have a complete blood count, blood culture, and antibiotic therapy. We hypothesized that utilizing the early-onset sepsis (EOS) risk calculator and a clinical symptom assessment could safely reduce the number of newborns subjected to laboratory testing and antibiotics.
We reviewed 698 well-appearing newborns of estimated gestational age of ≥34 weeks born to mothers with chorioamnionitis.
Sixty-five percent of newborns were managed according to the guidelines; 1 (0.14%) had culture-positive EOS. A strategy based on the use of the EOS calculator and clinical appearance of the newborn would have reduced the proportion having laboratory tests and antibiotics to 12% and would not have missed any cases of EOS.
The EOS risk in well-appearing newborns of mothers with chorioamnionitis is low. Applying a strategy based on readily obtainable measures rather than the obstetrical diagnosis of chorioamnionitis would result in a substantial reduction of newborns undergoing laboratory tests and being exposed to antibiotics. Further prospective trials evaluating the safety of this approach are warranted.
目前的建议是，患有绒毛膜羊膜炎的母亲所生新生儿应进行全血细胞计数、血培养及抗生素治疗。我们推测，使用早发型败血症（EOS）风险计算器和临床症状评估能够安全地减少接受实验室检查和抗生素治疗的新生儿数量。
我们回顾了698例胎龄≥34周、外观良好的患有绒毛膜羊膜炎母亲所生新生儿的情况。
65%的新生儿按照指南进行管理；1例（0.14%）血培养确诊为EOS。基于EOS计算器和新生儿临床表现的策略会将接受实验室检查和使用抗生素的比例降至12%，且不会漏诊任何EOS病例。
患有绒毛膜羊膜炎的母亲所生外观良好的新生儿发生EOS的风险较低。采用基于易于获得的指标而非绒毛膜羊膜炎产科诊断的策略，将大幅减少接受实验室检查和接触抗生素的新生儿数量。有必要进行进一步的前瞻性试验来评估该方法的安全性。
