Department of Obstetrics and Gynecology, University of Tennessee Medical Center, Knoxville, TN.
Department of Obstetrics and Gynecology, University of Tennessee Medical Center, Knoxville, TN.
Am J Obstet Gynecol. 2017 Jun;216(6):596.e1-596.e5. doi: 10.1016/j.ajog.2017.02.022. Epub 2017 Feb 16.
The current recommendation regarding the management of a term newborn delivered of a mother with an intrapartum fever or a diagnosis of clinical chorioamnionitis is that the neonate should have baseline laboratory work drawn along with blood cultures and be universally treated with antibiotics until culture results return. These guidelines report that the rate of intrapartum fever is about 3%; however, a few large studies suggest that the rate is higher at about 7%.
We sought to prospectively evaluate the rate of fever during labor in a large number of deliveries and determine the rate of early-onset neonatal sepsis in newborns delivered from mothers with an intrapartum fever compared with newborns delivered from mothers without intrapartum fever.
This was a prospective cohort study of all temperatures obtained in women in labor from Jan. 1, 2011, through June 30, 2014. Every patient with a fever of ≥38°C at ≥36 weeks' gestation was evaluated for gestational age, parity, spontaneous or induced labor, group B streptococcus status, regional anesthesia, mode of delivery, treatment with intrapartum antibiotics, and whether a clinical diagnosis of chorioamnionitis was made by the managing physician. Neonates were assessed for blood culture results, neonatal intensive care unit admission, length of stay, and any major newborn complications. Statistical analysis involved χ, Fisher exact, and Student t test.
A total of 412 patients (6.8%; 95% confidence interval, 6.2-7.5%) developed a fever in 6057 deliveries at ≥36 weeks' gestation. No cases of maternal sepsis occurred. Of the 417 newborns (5 sets of twins), only 1 (0.24%; 95% confidence interval, 0.01-1.3%) developed early-onset neonatal sepsis with a positive blood culture for Escherichia coli. There were 4 cases (0.07%; 95% confidence interval, 0.02-0.18%) of early-onset neonatal sepsis in the 5697 newborns (52 sets of twins) delivered from mothers who were not febrile and this difference was not significant (P = .3). The positive blood cultures in these 4 neonates were 3 group B streptococcus and 1 Enterococcus. The overall rate of early-onset neonatal sepsis in this population of newborns delivered at ≥36 weeks' gestation was 0.82/1000 deliveries.
The incidence of an intrapartum fever of ≥38°C in pregnancies at ≥36 weeks' gestation is common at 6.8% and this is consistent with the findings of a few other large retrospective studies. The rate of an intrapartum fever occurs in approximately 1 in 15 women in labor. The risk of neonatal sepsis in newborns delivered of mothers with intrapartum fever or a diagnosis of clinical chorioamnionitis is low at 0.24%, a rate that is <1 in 400. The recommendation for universal laboratory work, cultures, and antibiotic treatment pending culture results for this newborn population needs further examination.
目前对于产程中母亲发热或临床诊断为绒毛膜羊膜炎的足月新生儿的处理建议是，新生儿应进行基线实验室检查，包括血培养，并在培养结果回报前普遍使用抗生素治疗。这些指南报告说，产程中发热的发生率约为 3%；然而，一些大型研究表明，这一比例较高，约为 7%。
我们旨在前瞻性评估大量分娩中产程发热的发生率，并确定与无产程发热的母亲所分娩的新生儿相比，产程发热的母亲所分娩的新生儿中早发型新生儿败血症的发生率。
这是一项对 2011 年 1 月 1 日至 2014 年 6 月 30 日期间所有在产程中获得的体温的前瞻性队列研究。所有≥36 孕周、体温≥38°C 的发热患者均评估其胎龄、产次、自发性或诱导性分娩、B 组链球菌状态、区域麻醉、分娩方式、产程中使用抗生素以及是否由主治医生做出绒毛膜羊膜炎的临床诊断。对新生儿进行血培养结果、新生儿重症监护病房入院、住院时间和任何主要新生儿并发症的评估。统计分析包括 χ²、Fisher 确切检验和学生 t 检验。
在≥36 孕周的 6057 次分娩中，共有 412 例（6.8%；95%置信区间，6.2-7.5%）患者发热。无产妇脓毒症病例发生。在 417 名新生儿（5 对双胞胎）中，仅 1 名（0.24%；95%置信区间，0.01-1.3%）因大肠杆菌阳性血培养而发生早发型新生儿败血症。在 5697 名（52 对双胞胎）无发热母亲所分娩的新生儿中，有 4 例（0.07%；95%置信区间，0.02-0.18%）发生早发型新生儿败血症，差异无统计学意义（P=0.3）。这 4 例新生儿的阳性血培养分别为 3 例 B 组链球菌和 1 例肠球菌。在≥36 孕周分娩的这组新生儿中，早发型新生儿败血症的总体发生率为 0.82/1000 分娩。
在≥36 孕周的妊娠中，产程中发热≥38°C 的发生率为 6.8%，这与其他几项大型回顾性研究的结果一致。在产程中发热的发生率约为每 15 名产妇中有 1 名。产程发热或临床诊断为绒毛膜羊膜炎的母亲所分娩的新生儿发生新生儿败血症的风险较低，为 0.24%，即每 400 例新生儿中不到 1 例。对于这一新生儿人群，建议在培养结果回报之前，对所有新生儿进行普遍的实验室检查、培养和抗生素治疗，这一建议需要进一步研究。
