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Revisiting the diagnostic criteria of clinical chorioamnionitis in preterm birth
Author(s) -
Sung JH,
Choi SJ,
Oh Sy,
Roh CR,
Kim JH
Publication year - 2017
Publication title -
bjog: an international journal of obstetrics and gynaecology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.157
H-Index - 164
eISSN - 1471-0528
pISSN - 1470-0328
DOI - 10.1111/1471-0528.14176
Subject(s) - chorioamnionitis , medicine , neonatal sepsis , obstetrics , retrospective cohort study , cohort , neonatal infection , sepsis , pediatrics , premature rupture of membranes , pregnancy , gestational age , genetics , biology
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 outcome measures 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.