Clinical Dilemma of Positive Histologic Chorioamnionitis in Term Newborn

• Main Authors: Alain eCuna, Laleh eHakima, Yun-An eTseng, Bianca eFornier, Shahidul eIslam, Maria Lyn eQuintos-Alagheband, Poonam eKhullar, Barry eWeinberger, Nazeeh eHanna
• Format: Article
• Language: English
• Published: Frontiers Media S.A. 2014-04-01
• Series: Frontiers in Pediatrics
• Subjects: Infection; Sepsis; histologic chorioamnionitis; placental examination; term infant
• Online Access: http://journal.frontiersin.org/Journal/10.3389/fped.2014.00027/full
• ISSN: 2296-2360

Background: Although histologic chorioamnionitis (HCA) is known to be associated with poor outcomes in preterm infants, its clinical significance among term infants is not clearly known.<br/><br/>Objectives: To investigate the utility of HCA in determining early onset clinical sepsis (EOCS) among term newborns.<br/><br/>Methods: The incidence of HCA and EOCS in term infants born during 2008-2009 was evaluated in a single-center retrospective study (n = 3417). The predictive value of HCA for determining EOCS in term infants admitted to the NICU for suspected sepsis (n = 388) was quantified. Outcome of otherwise healthy term infants in the nursery with HCA was also investigated.<br/><br/>Results: Overall, 11% of term infants with HCA also had EOCS. HCA was associated with increased risk for EOCS (OR 2.6, 95% CI 1.6-4.2, p < 0.001) among term infants admitted to the NICU for suspected sepsis. No cases of EOCS were found among otherwise well-appearing infants in the nursery with HCA. Multiple logistic regression analysis indicated that addition of HCA does not increase the power of a model combining C-reactive protein and immature to total neutrophil ratio in determining EOCS.<br/><br/>Conclusions: Although HCA in term infants is associated with EOCS, it didn’t improve the ability of C-reactive protein and immature to total neutrophil ratio to predict EOCS. Routine placental examination may not contribute to the diagnosis of EOCS in term infants.