About the absence of the need to prescribe antibacterial therapy to newborns from mothers with clinical chorioamnionitis

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Abstract

Background. The diagnosis of a woman in labor “chorioamnionitis” (CA) implies a high risk of infectious complications for the mother and fetus, which determines the need for additional examination of infants and the decision on the appointment of antibacterial therapy. The purpouse of this study was determine the need to administration antibiotic therapy to full-term newborns from mothers diagnosed with chorioamnionitis.

Materials and methods. 113 full-term newborns were examined, of which the main group consisted of children whose mothers were diagnosed with “chorioamnionitis” (n = 77), the comparison group – children born to healthy mothers (n = 36). All children performed clinical and laboratory monitoring, including a clinical analysis of capillary blood in the first 24 hours of life; determination of the level of C-reactive protein (CRP) in venous blood on the 3rd day of life. Bacteriological examination of newborns included sampling of material from the ear fold, buccal mucosa, umbilical cord blood, as well as the contents of the tracheobronchial tree (TBD) – during respiratory therapy with mechanical ventilation. Special research methods included studies of the proinflammatory cytokines (IL-1β, IL-6) in umbilical cord blood. Histological CA was diagnosed in the presence of morphological and functional signs of inflammation in the placenta.

Results. Newborns of the main group more often developed respiratory disorders requiring respiratory and oxygen therapy (p = 0,045). The production of IL-1β, IL-6 in umbilical cord blood in the examined newborns of the main group was higher than in the comparison group [Odds Ratio (OR) 8.4; 95% Confidence Interval (CI): 1.0–67.9; OR 7.4; 95% CI: 2.5–21.7 respectively]. The study of blood samples revealed leukocytosis (>34·109) 6.5% vs 0%, p > 0.05) and a shift in the leukocyte count to young forms of neutrophils (45.4% vs 16.7%, p < 0.05) in the peripheral blood of infants of the main group. Infants exposed to maternal clinical chorioamnionitis had increased level of CRP 10.3 times more frequent (95% CI: 2.8–37.1) than in newborns in the comparison group. With dynamic clinical and laboratory monitoring, 72 children of the main group (93.5%) had no data for the course of the infection, as a result of which they did not receive antibiotic therapy.

Conclusion: Administration antibiotic therapy to clinically healthy full-term newborns from mothers diagnosed with chorioamnionitis is unjustified. Infants of this group require clinical laboratory, dynamic observation with laboratory control, including a clinical blood test and determination of the CRP level, which is a preferred alternative to the appointment of antibiotic therapy.

About the authors

Ekaterina A. Shevareva

Saint Petersburg State Pediatric Medical University, Ministry of Healthcare of the Russian Federation; Saint Petersburg State Budgetary Healthcare Institution of the City Perinatal Center No. 1

Author for correspondence.
Email: Shevareva_E.A@mail.ru

Applicant for the Department of Neonatology with courses in neurology and obstetrics-gynecology, anesthesiologist-resuscitator, neonatologist, department of resuscitation and intensive care

Russian Federation, Saint Petersburg; Saint Petersburg

Larisa A. Fedorova

Saint Petersburg State Pediatric Medical University, Ministry of Healthcare of the Russian Federation

Email: arslarissa@rambler.ru

MD, PhD, Associate Professor, Department of Neonatology with Courses in Neurology and Obstetrics-Gynecology

Russian Federation, Saint Petersburg

Oksana V. Nevmerzhitskaia

St. Petersburg State Pediatric Medical University, Ministry of Healthcare of the Russian Federation

Email: ovnevmer@list.ru

MD, PhD, Deputy Chief Physician for Neonatology, City Perinatal Center No. 1

Russian Federation, Saint Petersburg

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2. Fig. 1. The concentration of IL-1β in the umbilical cord blood in the examined newborns. Group I – children born to mothers with chorioamnionitis; group II – comparison group (healthy mother – child couple)

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3. Fig. 2. The concentration of IL-6 in the umbilical cord blood in the examined newborns. Group I – children born to mothers with chorioamnionitis; group II – comparison group (healthy mother – child couple)

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Copyright (c) 2021 Shevareva E.A., Fedorova L.A., Nevmerzhitskaia O.V.

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