The risk of early-onset neonatal sepsis in preterm infants with maternal histologic chorioamnionitis
Keywords:
maternal histologic chorioamnionitis, preterm, early-onset neonatal sepsis
Abstract
Background Chorioamnionitis, usually a subclinical condition, maycause preterm delivery and long-term morbidity.
Objective The objective of this study was to determine the risk of
early-onset neonatal sepsis in preterm infants with maternal histo-
logic chorioamnionitis (HCA).
Methods This was a prospective cohort study of preterm infants
born at Sanglah Hospital, Denpasar from September 2002 to Feb-
ruary 2004. Histopathological examinations of the subjects’ placen-
tas were done and the infants were monitored for 72 hours for clini-
cal signs of early-onset neonatal sepsis. Maternal and neonatal risk
factors were analyzed using multivariate statistical analysis.
Results Eighty-two preterm infants were included, of which 41 were
positive for maternal HCA. Twenty-five (61%) of the infants posi-
tive for maternal HCA developed early-onset neonatal sepsis, com-
pared to 5 (12%) of those negative for maternal HCA (RR=5, 95%CI
2.12;11.78). Nine infants died from early onset neonatal sepsis.
Eight of them had positive HCA, and only one had negative HCA.
The average length of hospital stay between infants with and with-
out maternal HCA did not differ significantly [12.0 (SD 5.08) vs.
12.6 (SD 1.34); P=0.80]. Logistic regression model analysis iden-
tified only HCA as a significant risk factor for early-onset neonatal
sepsis (OR=6.9, 95%CI 2.0;23). Gestational age (OR=1.3, 95%CI
0.8;2.0), birth weight (OR=1.0, 95%CI 0.9;1.0), and neonatal as-
phyxia (OR=1.0, 95%CI 0.1;4.4) were not found to be significant
risk factors.
Conclusion Preterm infants with maternal histologic
chorioamnionitis are at a higher risk for developing early-onset
neonatal sepsis
References
1. Wibowo N. Risiko dan pencegahan kelahiran prematur.
In: Suradi R, Monintja HE, Amalia P, Kusuma-
wardhani D, editors. Penanggulangan mutakhir bayi
prematur untuk menunjang kualitas sumber daya
manusia. Naskah lengkap pendidikan kedokteran
berkelanjutan FKUI XXXVIII. Jakarta: Balai Penerbit
FKUI, 1997.
2. Abadi A. Kontroversi dalam pengelolaan persalinan
kurang bulan. In: Tarjoto BH, Kosim MS, Deliana E,
Muarif YS, editors. Naskah lengkap kongres nasional
VIII perkumpulan perinatologi Indonesia dan
simposium internasional. Semarang: Perinasia Jawa
Tengah; 2001.
3. Swardewa TGA. Persalinan preterm di RSUP Denpasar
tahun 2000. Laboratorium Obstetri dan Ginekologi
FK UNUD/RSUP Denpasar.
4. Lockwood CJ. The Diagnosis preterm labor and the
prediction of preterm delivery. Clin Obstet Gynecol
1995;38:675-87.
5. Keelan JA, Coleman M, Mitchel MD. The Molecular
mechanism of term and preterm labor. Recent progress
and clinical implication. J Clin Endocrinol Metab
1996;81:2579-86.
6. Gravett MG, Hitti J, Hess DL, Eschenbach DA. In-
trauterine infection and preterm delivery: Evidence for
activation of the fetal hypothalamic-pituitary-adrenal
axis. Am J Obstet Gynecol 2000;182:1404-13.
7. Koh KS. Chorioamnionitis: Significance and treatment.
In: Mishell DR, Brenner PF, editors. Management of
common problems in obstetrics and gynecology. 3rd
ed. Oxford: Blackwall Scientific Publication; 1994.
p.116-20.
8. Gibs RS, Duff P. Progress in pathogenesis and manage-
ment of clinical intraamniotic infection. Am J Obstet
Gynecol 1991;164:1371-26.
9. Salafia CM, Vintzileos AM. Why all placenta should
be examined by a pathologist. Am J Obstet Gynecol
1990;165:934-8.
10. Gibbs RK, Romero R, Hillier SL, Eschenbach DA, Sweet
RL. A Review of premature birth and sub clinical infec-
tions. Am J Obstet Gynecol 1988;166:1515-28.
11. Chandra S, Kaban RM, Tanjung MT, Rahmad.
Hubungan korioamnionitis dengan persalinan preterm.
Bagian Obstetri dan Ginekologi FK USU RSHA-RSP
Medan.
12. Smullian JC, Shen-Schwarz S, Vintzileos ANM, Lake
MGF, Ananth CV. Clinical chorioamnionitis and his-
tologic placental inflammation. J Obstet Gynecol
1999;6:1000-5.
13. Baley JE, Goldfar J. Neonatal infection. In: Klaus MH,
Fanaroff AA, editors. Care of the high-risk neonate.
4th ed. Philadelphia: WB Saunders, 1993. p. 392-16.
14. Linda LB, Ohning BL. Neonatal Sepsis. Available from:
URL: http://emedicine.com/PED/topic2630.htm.
15. Yu VYH, Monintja HE. Beberapa masalah dalam
perawatan intensif neonatus. Jakarta: Balai Penerbit
FKUI; 1997. p. 217-30.
16. Pittard III WB. Classification of low birth weight. In:
Klaus MH, Fanaroff AA, editors. Care of the high-risk
neonate. 4th ed. Philadelphia: WB Saunders; 1993. p.
101-33.
17. Tumbelaka AR, Riono P, Sastroasmoro S, Wirjodiarjo
M, Pudjiastuti P, Firman K. Pemilihan uji hipotesis. In:
Sastroasmoro S, Ismael S, editors. Dasar-dasar
metodologi penelitian klinis. 2nd ed. Jakarta: Balai
Penerbit FKUI; 2002. p. 240-58.
18. Saling E. Current measures to prevent late abortion or
prematurity. Presented at Symposium Perinatology from
the 26 th Nestle Nutrition Workshop.
19. Guin D, Gibbs R. Infection-related preterm birth: A
review of the evidence. Neo Rev 2002;5:e86-e96.
20. Hillier SL, Krohn MA, Kiviat NB, Watts DH,
Eschenbach DA. Microbiologic causes and neonatal
outcomes with chorioamnionitis infection. Am J Obstet
Gynecol 1991;165:955-61.
21. Russel P. Inflammatory lesion of the placenta. Clinical
significance of acute chorioamnionitis. Am J Diag
Gynecol Obstet 1992;1:127-37.
22. Yancey MK, Duff P, Kubilis P, Clark P, Frentzent. Risk
factors for neonatal sepsis. Obstet Gynecol 1996;
87:188-194.
23. Soman M, Green B, Daling J. Risk factors for early
neonatal sepsis. Am J Epidemiol 1985;121:712-19.
24. Korbage de Araujo MC, Shcultz R, Vaz FAC, Massad
E, Feferbaum R, Lauro de Araujo Ramoz. A Case-con-
trol study of histological chorioamnionitis and neona-
tal infection. Early Hum Dev 1994;40:51-8.
25. Beebe LA, Cowan LD, Altshuler G. The epidemiology
of placental features: Association with gestational age
and neonatal outcome. Obstet Gynecol 1996;87:771-
78.
26. Martius JA, Roos T, Gora B, Oehler MK, Schroad L,
Papadiopoulos T, et al. Risk factors associated with
early-onset sepsis in premature infants. Eur J Obstet
Gynecol Reprod Biol 1999;85:151-8.
27. Hauth JC, Goldenberg RL, Andrews WW, DuBarg MB,
Copper RL. Reduced incidence of preterm delivery with
metronidazole and erythromycin in women with bac-
terial vaginosis. N Engl J Med 1995;333:173-26.
28. Morales WJ, Schrorr S, Albritton J. Effect of metron-
idazole in patient with preterm birth in proceeding
pregnancy and bacterial vaginosis: Placebo-controlled,
double-blind study. Am J Obstet Gynecol 1994;171:
345-9.
29. Mc Donald HM, O’Loughlin JA, Vigneswaran R, et al.
Impact of metronidazole therapy on preterm birth in
women with bacterial vaginosis flora (Gardnerella
vaginalis): A randomized, placebo-controlled trial. Br
J Obstet Gynecol 1997;104:131-7.
30. Joesoef, Hillier SL, Wignjosastro G. Intravaginal
clindamycin treatment for bacterial vaginosis. Effect
on preterm delivery and low birth weight. Am J Obstet
Gynecol 1995;173:1527-31.
31. Carey JC, Klebanoff MA, Hauth JC. Metronidazole to
prevent preterm delivery in pregnant women in asymp-
tomatic bacterial vaginosis. N Engl J 2000;342:534-
40.
32. Gibs RS, Eschenbach DA. Use to antibiotics to pre-
vent preterm birth. Am J Obstet Gynecol 1997;177:
375-80.
33. Centers of Disease control and Prevention. Preven-
tion of perinatal group B streptococcal disease: A pub-
lic health perspective. Morb Mortal Wkly Rep
1996;45(RR-7):1-24.
34. Velaphi S, Siegel JD, Wendel GD, Cushion N, Eid WM,
Sanchez PJ. Early-onset group B streptococcal infec-
tion after a combined maternal and neonatal group B
streptococcal chemoprophylaxis strategy. Pediatrics
2003;111:542-47.
In: Suradi R, Monintja HE, Amalia P, Kusuma-
wardhani D, editors. Penanggulangan mutakhir bayi
prematur untuk menunjang kualitas sumber daya
manusia. Naskah lengkap pendidikan kedokteran
berkelanjutan FKUI XXXVIII. Jakarta: Balai Penerbit
FKUI, 1997.
2. Abadi A. Kontroversi dalam pengelolaan persalinan
kurang bulan. In: Tarjoto BH, Kosim MS, Deliana E,
Muarif YS, editors. Naskah lengkap kongres nasional
VIII perkumpulan perinatologi Indonesia dan
simposium internasional. Semarang: Perinasia Jawa
Tengah; 2001.
3. Swardewa TGA. Persalinan preterm di RSUP Denpasar
tahun 2000. Laboratorium Obstetri dan Ginekologi
FK UNUD/RSUP Denpasar.
4. Lockwood CJ. The Diagnosis preterm labor and the
prediction of preterm delivery. Clin Obstet Gynecol
1995;38:675-87.
5. Keelan JA, Coleman M, Mitchel MD. The Molecular
mechanism of term and preterm labor. Recent progress
and clinical implication. J Clin Endocrinol Metab
1996;81:2579-86.
6. Gravett MG, Hitti J, Hess DL, Eschenbach DA. In-
trauterine infection and preterm delivery: Evidence for
activation of the fetal hypothalamic-pituitary-adrenal
axis. Am J Obstet Gynecol 2000;182:1404-13.
7. Koh KS. Chorioamnionitis: Significance and treatment.
In: Mishell DR, Brenner PF, editors. Management of
common problems in obstetrics and gynecology. 3rd
ed. Oxford: Blackwall Scientific Publication; 1994.
p.116-20.
8. Gibs RS, Duff P. Progress in pathogenesis and manage-
ment of clinical intraamniotic infection. Am J Obstet
Gynecol 1991;164:1371-26.
9. Salafia CM, Vintzileos AM. Why all placenta should
be examined by a pathologist. Am J Obstet Gynecol
1990;165:934-8.
10. Gibbs RK, Romero R, Hillier SL, Eschenbach DA, Sweet
RL. A Review of premature birth and sub clinical infec-
tions. Am J Obstet Gynecol 1988;166:1515-28.
11. Chandra S, Kaban RM, Tanjung MT, Rahmad.
Hubungan korioamnionitis dengan persalinan preterm.
Bagian Obstetri dan Ginekologi FK USU RSHA-RSP
Medan.
12. Smullian JC, Shen-Schwarz S, Vintzileos ANM, Lake
MGF, Ananth CV. Clinical chorioamnionitis and his-
tologic placental inflammation. J Obstet Gynecol
1999;6:1000-5.
13. Baley JE, Goldfar J. Neonatal infection. In: Klaus MH,
Fanaroff AA, editors. Care of the high-risk neonate.
4th ed. Philadelphia: WB Saunders, 1993. p. 392-16.
14. Linda LB, Ohning BL. Neonatal Sepsis. Available from:
URL: http://emedicine.com/PED/topic2630.htm.
15. Yu VYH, Monintja HE. Beberapa masalah dalam
perawatan intensif neonatus. Jakarta: Balai Penerbit
FKUI; 1997. p. 217-30.
16. Pittard III WB. Classification of low birth weight. In:
Klaus MH, Fanaroff AA, editors. Care of the high-risk
neonate. 4th ed. Philadelphia: WB Saunders; 1993. p.
101-33.
17. Tumbelaka AR, Riono P, Sastroasmoro S, Wirjodiarjo
M, Pudjiastuti P, Firman K. Pemilihan uji hipotesis. In:
Sastroasmoro S, Ismael S, editors. Dasar-dasar
metodologi penelitian klinis. 2nd ed. Jakarta: Balai
Penerbit FKUI; 2002. p. 240-58.
18. Saling E. Current measures to prevent late abortion or
prematurity. Presented at Symposium Perinatology from
the 26 th Nestle Nutrition Workshop.
19. Guin D, Gibbs R. Infection-related preterm birth: A
review of the evidence. Neo Rev 2002;5:e86-e96.
20. Hillier SL, Krohn MA, Kiviat NB, Watts DH,
Eschenbach DA. Microbiologic causes and neonatal
outcomes with chorioamnionitis infection. Am J Obstet
Gynecol 1991;165:955-61.
21. Russel P. Inflammatory lesion of the placenta. Clinical
significance of acute chorioamnionitis. Am J Diag
Gynecol Obstet 1992;1:127-37.
22. Yancey MK, Duff P, Kubilis P, Clark P, Frentzent. Risk
factors for neonatal sepsis. Obstet Gynecol 1996;
87:188-194.
23. Soman M, Green B, Daling J. Risk factors for early
neonatal sepsis. Am J Epidemiol 1985;121:712-19.
24. Korbage de Araujo MC, Shcultz R, Vaz FAC, Massad
E, Feferbaum R, Lauro de Araujo Ramoz. A Case-con-
trol study of histological chorioamnionitis and neona-
tal infection. Early Hum Dev 1994;40:51-8.
25. Beebe LA, Cowan LD, Altshuler G. The epidemiology
of placental features: Association with gestational age
and neonatal outcome. Obstet Gynecol 1996;87:771-
78.
26. Martius JA, Roos T, Gora B, Oehler MK, Schroad L,
Papadiopoulos T, et al. Risk factors associated with
early-onset sepsis in premature infants. Eur J Obstet
Gynecol Reprod Biol 1999;85:151-8.
27. Hauth JC, Goldenberg RL, Andrews WW, DuBarg MB,
Copper RL. Reduced incidence of preterm delivery with
metronidazole and erythromycin in women with bac-
terial vaginosis. N Engl J Med 1995;333:173-26.
28. Morales WJ, Schrorr S, Albritton J. Effect of metron-
idazole in patient with preterm birth in proceeding
pregnancy and bacterial vaginosis: Placebo-controlled,
double-blind study. Am J Obstet Gynecol 1994;171:
345-9.
29. Mc Donald HM, O’Loughlin JA, Vigneswaran R, et al.
Impact of metronidazole therapy on preterm birth in
women with bacterial vaginosis flora (Gardnerella
vaginalis): A randomized, placebo-controlled trial. Br
J Obstet Gynecol 1997;104:131-7.
30. Joesoef, Hillier SL, Wignjosastro G. Intravaginal
clindamycin treatment for bacterial vaginosis. Effect
on preterm delivery and low birth weight. Am J Obstet
Gynecol 1995;173:1527-31.
31. Carey JC, Klebanoff MA, Hauth JC. Metronidazole to
prevent preterm delivery in pregnant women in asymp-
tomatic bacterial vaginosis. N Engl J 2000;342:534-
40.
32. Gibs RS, Eschenbach DA. Use to antibiotics to pre-
vent preterm birth. Am J Obstet Gynecol 1997;177:
375-80.
33. Centers of Disease control and Prevention. Preven-
tion of perinatal group B streptococcal disease: A pub-
lic health perspective. Morb Mortal Wkly Rep
1996;45(RR-7):1-24.
34. Velaphi S, Siegel JD, Wendel GD, Cushion N, Eid WM,
Sanchez PJ. Early-onset group B streptococcal infec-
tion after a combined maternal and neonatal group B
streptococcal chemoprophylaxis strategy. Pediatrics
2003;111:542-47.
Published
2016-10-10
How to Cite
1.
Adnyana I, Soetjiningsih S. The risk of early-onset neonatal sepsis in preterm infants with maternal histologic chorioamnionitis. PI [Internet]. 10Oct.2016 [cited 22Nov.2024];45(4):160-. Available from: https://paediatricaindonesiana.org/index.php/paediatrica-indonesiana/article/view/829
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Received 2016-10-08
Accepted 2016-10-08
Published 2016-10-10
Accepted 2016-10-08
Published 2016-10-10
