Revisiting the diagnostic criteria of clinical chorioamnionitis in preterm birth.
BJOG
; 124(5): 775-783, 2017 Apr.
Article
em En
| MEDLINE
| ID: mdl-27365145
ABSTRACT
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 OUTCOMEMEASURES:
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.Palavras-chave
Texto completo:
1
Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Corioamnionite
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Sepse Neonatal
Tipo de estudo:
Diagnostic_studies
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Etiology_studies
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Incidence_studies
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Observational_studies
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Prevalence_studies
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Prognostic_studies
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Risk_factors_studies
Limite:
Adolescent
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Adult
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Female
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Humans
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Infant
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Male
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Middle aged
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Newborn
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Pregnancy
País/Região como assunto:
Asia
Idioma:
En
Revista:
BJOG
Assunto da revista:
GINECOLOGIA
/
OBSTETRICIA
Ano de publicação:
2017
Tipo de documento:
Article