Mahdieh Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Pediatrics Infections Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Arch Iran Med. 2020 Jul 1;23(7):480-487. doi: 10.34172/aim.2020.45.
Chorioamnionitis (CAM) is one of the major risk factors for neonatal early-onset sepsis (EOS). Different international guidelines have been developed for diagnosis and care of such neonates. This research aimed to evaluate our neonates and compare them with the guidelines.
This prospective cohort study was conducted during five years (March 2012 to March 2017), and comprised of neonates (any gestational age) born to mothers with CAM (any criteria). The neonates' clinical findings and interventions were collected and analyzed.
In total, out of 28,988 live born neonates, CAM was found in mothers of 169 neonates (1.7%). Among the studied neonates, 30.8% were born ≤34 week of gestation, 39% had birth weight <2500 g, and 58.6% were asymptomatic. Out of 99 asymptomatic neonates, 47 were observed near mothers and 52 admitted to the neonatal intensive care unit (NICU). The frequency of abnormal tests was 23.07% in asymptomatic vs. 35.7% in symptomatic neonates; three neonates developed culture positive EOS (2.75%) and 68.05% of the neonates received antibiotics. The length of stay was 2.59 ± 1.13 (median = 2.00, IQR = 1.00) days in asymptomatic vs. 15.15 ± 13.67 (median = 7.00, IQR = 15.25) days in symptomatic neonates (P<0.001).
The use of guidelines increased the length of stay, lab tests, and antibiotics in asymptomatic and neonates with negative blood culture. In addition to the mother-neonate separation, these guidelines may increase nosocomial infection, antibiotic resistance, and costs; therefore, new guidelines are needed to be developed.
绒毛膜羊膜炎（CAM）是新生儿早发性败血症（EOS）的主要危险因素之一。已经制定了不同的国际指南来诊断和护理此类新生儿。本研究旨在评估我们的新生儿，并将其与指南进行比较。
这项前瞻性队列研究在五年期间（2012 年 3 月至 2017 年 3 月）进行，纳入了母亲患有 CAM（任何标准）的任何胎龄新生儿（任何胎龄）。收集和分析了新生儿的临床发现和干预措施。
在 28988 例活产新生儿中，有 169 例（1.7%）母亲患有 CAM。在所研究的新生儿中，30.8%出生于≤34 孕周，39%出生体重<2500g，58.6%无症状。在 99 例无症状新生儿中，47 例在母亲附近观察，52 例收入新生儿重症监护病房（NICU）。无症状组异常检查的频率为 23.07%，而有症状组为 35.7%；3 例新生儿发生培养阳性 EOS（2.75%），68.05%的新生儿接受了抗生素治疗。无症状组的住院时间为 2.59±1.13（中位数=2.00，IQR=1.00）天，有症状组为 15.15±13.67（中位数=7.00，IQR=15.25）天（P<0.001）。
使用指南增加了无症状和血培养阴性新生儿的住院时间、实验室检查和抗生素的使用。除了母婴分离外，这些指南还可能增加医院感染、抗生素耐药性和费用；因此，需要制定新的指南。
