重新审视早产时临床绒毛膜羊膜炎的诊断标准。
Revisiting the diagnostic criteria of clinical chorioamnionitis in preterm birth.
机构信息
Department of Obstetrics and Gynaecology, Samsung Medical Centre, Sungkyunkwan University School of Medicine, Seoul, Korea.
出版信息
BJOG. 2017 Apr;124(5):775-783. doi: 10.1111/1471-0528.14176. Epub 2016 Jul 1.
OBJECTIVE
To re-evaluate the utility of the conventional criteria for clinical chorioamnionitis in the prediction of early-onset neonatal sepsis (EONS) in preterm birth.
DESIGN
Retrospective cohort study.
SETTING
Seoul, Republic of Korea.
SAMPLE
A total of 1468 singleton births between 24 and 34 weeks due to preterm labour (n = 713) or preterm prelabour rupture of membranes (n = 755).
METHOD
We evaluated three diagnostic categories of clinical chorioamnionitis: Criteria 1, conventional criteria; Criteria 2, combination of any three conventional parameters without prerequisite fever; Criteria 3, Criteria 1 plus positive maternal C-reactive protein and neutrophil left-shift into minor criteria. EONS included proven or suspected sepsis within 7 days following birth. Neonatal morbidity and mortality of EONS were also reviewed.
MAIN OUTCOME MEASURES
Diagnostic performance of three combinations.
RESULTS
The prevalence of EONS was 13.8%. Among 203 cases of EONS, maternal manifestation of clinical chorioamnionitis by criteria 1 was evident in only one out of seven, indicating 15.3% sensitivity for EONS prediction. However, with application of criteria 2, sensitivity significantly increased to 34.0%, while compromising specificity from 92.3% to 78.7%. Criteria 3 showed similar diagnostic performance compared with criteria 1 (sensitivity 16.7%, specificity 91.6%). Overall, neonatal mortality and neonatal composite morbidity in EONS were 14.9% and 67.8%, respectively, and there was no difference in neonatal morbidity and mortality between neonates whose mothers showed fever as a sign of clinical chorioamnionitis and those whose mothers did not.
CONCLUSION
The renouncement of fever as a prerequisite for the criteria of clinical chorioamnionitis could increase sensitivity for the identification of EONS, a serious outcome of preterm birth.
TWEETABLE ABSTRACT
The renouncement of fever as an essential can increase sensitivity for prediction of neonatal sepsis.
目的
重新评估传统临床绒毛膜羊膜炎标准在预测早产中早发性新生儿败血症（EOS）中的作用。
设计
回顾性队列研究。
地点
韩国首尔。
样本
总共 1468 名单胎分娩，因早产临产（n=713）或早产未临产胎膜早破（n=755）。
方法
我们评估了三种临床绒毛膜羊膜炎诊断类别：标准 1，传统标准；标准 2，没有发热先决条件的三个常规参数的组合；标准 3，标准 1 加阳性母体 C 反应蛋白和中性粒细胞向次要标准的左移。EOS 包括出生后 7 天内确诊或疑似败血症。还回顾了 EOS 的新生儿发病率和死亡率。
主要观察指标
三种组合的诊断性能。
结果
EOS 的患病率为 13.8%。在 203 例 EOS 中，只有 1 例/7 例的母亲临床表现符合标准 1 的临床绒毛膜羊膜炎，提示其对 EOS 预测的敏感性为 15.3%。然而，应用标准 2 后，敏感性显著提高至 34.0%，同时特异性从 92.3%降至 78.7%。标准 3 与标准 1 相比具有相似的诊断性能（敏感性 16.7%，特异性 91.6%）。总的来说，EOS 新生儿死亡率和新生儿复合发病率分别为 14.9%和 67.8%，且母亲表现出临床绒毛膜羊膜炎发热体征的新生儿与未表现出发热体征的新生儿在新生儿发病率和死亡率方面无差异。
结论
放弃将发热作为临床绒毛膜羊膜炎标准的必要条件可以提高对早产严重后果 EOS 的识别敏感性。
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