Improved efficiency in the management of newborns with infectious risk factors by the sepsis risk calculator and clinical observation

Abstract Objective To evaluate the efficiency of the sepsis risk calculator and the serial clinical observation in the management of late preterm and term newborns with infectious risk factors. Method Single-center, observational, two-phase cohort study comparing the rates of neonates born ≥35 weeks' gestation, ≥2000 g birthweight, and without major congenital anomalies, who were screened and/or received antibiotics for early-onset neonatal sepsis risk at our center during two periods, before (January/2018-June/2019) and after (July/2019-December/2020) the implementation of the sepsis risk calculator. Results A total of 1796 (Period 1) and 1867 (Period 2) patients with infectious risk factors were included. During the second period, tests to rule out sepsis were reduced by 34.0 % (RR, 95 %CI): 0.66 (0.61, 0.71), blood cultures by 13.1 %: 0.87 (0.77, 0.98), hospital admissions by 13.5 %: 0.86 (0.76, 0.98) and antibiotic administration by 45.9 %: 0.54 (0.47, 0.63). Three cases of early-onset neonatal sepsis occurred in the first period and two in the second. Clinical serial evaluation would have detected all true cases. Conclusions The implementation of a sepsis risk calculator in the management of newborns ≥35 weeks GA, ≥2000 g birthweight, without major congenital anomalies, with infectious risk factors is safe and adequate to reduce laboratory tests, blood cultures, hospital admissions, and antibiotics administration. Serial clinical observation, in addition, could be instrumental to achieve or even improve this goal.

Corioamnionitis histológica y neurodesarrollo en niños prematuros menores de 34 semanas, Lima-Perú

Para determinar los efectos de la corioamnionitis histológica en el neurodesarrollo de los prematuros menores de 34 semanas evaluados a los 2 años de edad corregida se realizó un estudio secundario de casos y controles. Fueron analizados los datos clínicos, hallazgos histológicos de la placenta e índices del desarrollo medidos por la Escala Bayley III de 38 niños expuestos y 53 niños no expuestos. Las infecciones genitourinarias de la madre y la sepsis precoz fueron más frecuentes en el grupo expuesto (p<0,005). Las dimensiones del desarrollo cognitivo, motor y lenguaje fueron normales en ambos grupos. Los expuestos al subtipo subcorionitis obtuvieron menor desempeño en las tres dimensiones. La corioamnionitis histológica no mostró influencia sobre el neurodesarrollo en prematuros menores de 34 semanas a los 2 años de edad. Se recomienda estudios longitudinales y multicéntricos para definir los efectos a largo plazo.

SUMMARY The objective of this study was to determine the effects of histologically diagnosed chorioamnionitis on neurodevelopment of premature babies born with less than 34-week gestational age who were assessed at two-year corrected age. A secondary case-control study was carried out. Clinical data, placental histological findings, and development indexes assessed using the Bayley III scale were analyzed in 38 exposed children and 53 non-exposed children. Genitourinary infections in mothers and early sepsis were more frequent in the exposed group (p<0.005). Cognitive development, motor development and language were normal in both groups. Those children exposed to the chorionitis subtype had lower scores in the aforementioned variables. Histologically diagnosed chorioamnionitis did not show any influence on neurodevelopment in premature babies born with less than 34-week gestational age when they were assessed at two years. Longitudinal and multicenter studies are advised in order to define the long-term effects.

Predictive value of serum inflammatory markers for histological chorioamnionitis among women with preterm premature rupture of membranes after undergoing cervical cerclage

ABSTRACT Purpose: To determine the predictive value of maternal White Blood Cells (WBC), neutrophils, and C-Reactive Protein (CRP) for diagnosing Histological Chorioamnionitis (HCA) among women with Preterm Premature Rupture of Membranes (PPROM) who underwent cervical cerclage. Methods: A retrospective cross-sectional study was conducted among women with singleton pregnancy and PPROM, who underwent cervical cerclage during 2018-2020. Results: A total of 55 eligible women were included in the final analysis, including 36 (61.02%) cases with HCA and 19 (38.98%) without HCA. Women with HCA had higher WBC count (12.31 ± 2.80) × 109/L and neutrophil count (9.67 ± 2.90)×109/L than those without HCA (10.35 ± 2.53) × 109/L and 7.82 ± 2.82 × 109/L, respectively) (both p < 0.05). The cut-off value of WBC count at 10.15×109/L was found to be the most effective in identifying HCA, with an Area Under Curve (AUC) of 0.707 (95% CI: 0.56-0.86; p = 0.012), sensitivity of 86.11%, specificity of 57.90%, Positive Predictive Value (PPV) of 79.49%, Negative Predictive Value (NPV) of 68.75%, and Youden index of 0.44. The combination of WBC + neutrophil had a slightly higher (AUC = 0.711, 95% CI: 0.57-0.86; p = 0.011), specificity (68.42%), and PPV (81.25%), but lower sensitivity (72.22%), than the WBC count alone. A cut-off value of neutrophil at 7.46 × 109/L was effective in identifying HCA, with an AUC of 0.689 (95% CI: 0.53-0.84; p = 0.022). Discussion: Combination use of WBC+neutrophil was found to be the most accurate predictor of HCA among women with PPROM after surgery of cervical cerclage.

Interaction of B-group streptococcal infection and chorioamnionitis in low birth weight infants during late pregnancy / 中国医师杂志

Objective:To investigate the interaction of B-group streptococcal infection and chorioamnionitis (CAM) with late pregnancy and low birth weight infant (LBWI).Methods:A retrospective study was conducted on 524 postpartum women who underwent regular prenatal examinations and completed delivery at the Taizhou Second People′s Hospital from October 2019 to April 2022. According to their newborn birth weight, they were divided into normal group (466 cases) and LBWI group (58 cases). The age, pregnancy times, birth times, pregnancy body mass index (BMI), cesarean section history, abortion history, anemia during pregnancy, hypertensive disorder during pregnancy, diabetes during pregnancy, vaginitis, B-group streptococcal infection, CAM, premature rupture of membranes, postpartum hemorrhage, puerperal infection, neonatal preterm delivery, neonatal asphyxia, neonatal infection, fetal distress were compared between the two groups. The influencing factors of LBWI were analyzed using logistic regression. The correlation and interaction between B-group streptococcal infection and CAM on LBWI were analyzed.Results:There was a statistically significant difference in age, history of miscarriage, gestational hypertension, vaginitis, B-group streptococcal infection, CAM, premature rupture of membranes, neonatal preterm birth, neonatal infection and fetal distress between the two groups (all P<0.05). The results of logistic regression analysis showed that gestational hypertension, B-group streptococcal infection, CAM, premature rupture of membranes, preterm birth, neonatal infection, and fetal distress were risk factors for LBWI (all P<0.05). B-group streptococcal infection, CAM, and LBWI were positively correlated ( r=0.587, 0.604, all P<0.001). The interaction analysis results showed a positive correlation between B-group streptococcal infection, CAM, and LBWI (all P<0.001). Conclusions:B-group streptococcal infection in late pregnancy, CAM, and LBWI are positively correlated, and their coexistence can increase the risk of LBWI.

Corioamnionitis Histológica Asociada a Muerte Fetal / Histological Chorioamnionitis Associated with Fetal Death

INTRODUCCIÓN. Anualmente ocurren más de 2 millones de muertes fetales a nivel mundial, siendo fundamental el estudio anatomopatológico placentario para disminuir el número de muertes inexplicadas. OBJETIVO. Revisar la literatura existente acerca de corioamnionitis histológica, los criterios para establecer su diagnóstico, su presencia y posible asociación en estudios de causas de muerte fetal. METODOLOGÍA. Se realizaron búsquedas en bases de datos electrónicas para recopilar estudios de causas de muerte fetal que incluyeron corioamnionitis histológica. RESULTADOS. Se encontraron 13 estudios que evaluaron mortalidad fetal y que entre sus causas incluyeron corioamnionitis histológica. DESARROLLO. El estudio microscópico placentario en muertes fetales es esencial al investigar una muerte fetal. Las anomalías placentarias son la causa más común de muerte fetal, la corioamnionitis aguda es la lesión inflamatoria más frecuente. Se detallaron los criterios más relevantes para definir corioamnionitis aguda histológica pero aún no se establece un consenso. Estudios de causas de muerte fetal en años recientes han reportado corioamnionitis histológica entre 6,3% y 41,3% de casos. Las alteraciones inflamatorias del líquido amniótico son una causa importante de muerte fetal, siendo la corioamnionitis la más frecuente en este grupo. CONCLUSIÓN. En estudios para determinar las causas de muerte fetal se evidenció corioamnionitis aguda histológica en hasta el 41,3% de casos, por lo que podría estar asociada a dicho evento. Sin embargo, es necesario establecer un sistema de estadiaje de corioamnionitis histológica mediante un panel de expertos a nivel mundial.

INTRODUCTION. Annually more than 2 million fetal deaths occur worldwide, being fundamental the placental anatomopathological study to reduce the number of unexplained deaths. OBJECTIVE. To review the existing literature on histological chorioamnionitis, the criteria to establish its diagnosis, its presence and possible association in studies of causes of fetal death. METHODOLOGY. Electronic databases were searched to collect studies of causes of fetal death that included histologic chorioamnionitis. RESULTS. Thirteen studies were found that evaluated fetal mortality and that included histologic chorioamnionitis among their causes. DEVELOPMENT: Placental microscopic study in fetal deaths is essential when investigating a fetal death. Placental abnormalities are the most common cause of fetal death, acute chorioamnionitis being the most frequent inflammatory lesion. The most relevant criteria for defining histologic acute chorioamnionitis have been detailed but consensus has not yet been established. Studies of causes of fetal death in recent years have reported histologic chorioamnionitis in between 6,3% and 41,3% of cases. Inflammatory changes in the amniotic fluid are an important cause of fetal death, with chorioamnionitis being the most frequent in this group. CONCLUSIONS. In studies to determine the causes of fetal death, histological acute chorioamnionitis was evidenced in up to 41,3% of cases, so it could be associated with this event. However, it is necessary to establish a histological chorioamnionitis staging system by means of a worldwide panel of experts.

Establishment and validation of predictive model for histologic chorioamnionitis during expected treatment of preterm premature rupture of membrane before 34 weeks of gestation / 中华围产医学杂志

Objective:To establish and verify a model to predict histologic chorioamnionitis (HCA) for women during expected management of preterm premature rupture of membranes (PPROM) at 24-34 weeks of gestation.Methods:This retrospective study enrolled 493 pregnant women who were diagnosed with PPROM at 24-33 +6 weeks of gestation and delivered in Peking University Third Hospital from January 1, 2012, to December 31, 2020. They were randomly divided into the modeling set ( n=345) and validation set ( n=148) at a ratio of 7∶3. Basic information, risk factors, clinical treatment, and maternal and infant outcomes were compared between participants with and without HCA using Chi-square test, t test, or Mann-Whitney U test. Multivariate logistic regression analysis was performed to analyze the independent risk factors for HCA. The predictive values of different indexes for HCA were compared and the predictive model was then established and verified using the receiver operating characteristic (ROC) curve and area under curve (AUC). Results:There were no significant differences in the basic information, common risk factors for premature rupture of membranes (PROM), or the use of tocolytics, antibiotics or dexamethasone between women in the HCA and non-HCA groups (all P>0.05). Compared with the non-HCA group, the HCA group showed an earlier onset of PROM [31.3 (24.0-33.9) vs 32.3 (27.0-33.9) gestational weeks, U=4 103.00, P=0.017], longer expected treatment [66.5 (0.7-895.3) vs 18.0 (0.3-1 123.0) h, U=1 791.00, P<0.001] and higher incidence of neonatal asphyxia, sepsis, and intracranial hemorrhage [24.3% (58/239) vs 13.2% (14/106), χ 2=5.44; 9.6% (23/239) vs 2.8% (3/106), χ 2=4.86; 41.0% (98/239) vs 17.9% (19/106), χ 2=17.45; all P<0.05]. Moreover, the positive rate of bacterial culture, C-reactive protein (CRP) level, neutrophil/lymphocyte ratio (NLR), white blood cell (WBC) and neutrophil counts were significantly increased in the HCA group [37.2% (89/239) vs 22.6% (24/106), χ 2=7.10; 8.2 (0.0-273.0) vs 5.0 (0.0-218.9) ng/ml, U=2 419.00; 5.6 (1.2-58.6) vs 4.6 (1.7-18.7), U=2 357.50; 11.9 (4.5-30.0)×10 9/L vs 10.1 (5.8-21.8)×10 9/L, U=4 074.50; 9.5 (2.5-28.1)×10 9/L vs 7.6 (3.5-18.5)×10 9/L, U=4 021.50; all P<0.05], while the lymphocyte count was decreased [1.5 (0.5-3.7)×10 9/L vs 1.6 (0.7-3.9)×10 9/L, U=4 237.00, P=0.017]. CRP level, NLR, the gestational week at the onset of PROM and the duration of expected treatment were independent risk factors for HCA ( OR=1.069, 95% CI: 1.024-1.117; OR=1.192, 95% CI: 1.048-1.356; OR=0.906, 95% CI: 0.867-0.947; OR=1.017, 95% CI: 1.007-1.026). Based on the four risk factors, the predictive model was established and ROC curve was drawn. AUC for evaluating the performance of the predictive model was 0.880, which indicated a clinical significance. Conclusion:The model established based on the four risk factors, which were CRP level, NLR, the gestational week at onset of PROM and the duration of expected treatment, performs well in the prediction of HCA in women with PPROM during expected treatment and has good clinical practical value.

Síndrome de respuesta inflamatoria fetal: fisiopatología, desenlaces y estudio ecográfico prenatal / Feltal inflamatory response syndrome: Pathophysiology, outcomes, and prenatal ultrasound study

Resumen OBJETIVO: Ofrecer al lector información amplia y suficiente acerca de este síndrome, con hincapié en el reconocimiento del daño multiorgánico fetal, que permita darle herramientas para establecer el diagnóstico oportuno y disminuir la morbilidad y mortalidad fetal y neonatal. METODOLOGÍA: Estudio retrospectivo con base en la búsqueda en las bases de datos de PubMed, EBSCO y Ovid de 2016 a 2021 de artículos de revisión, investigaciones originales, guías de práctica clínica y protocolos. Además, artículos clásicos y los correspondientes a búsquedas manuales para lograr la contextualización de los puntos tratados. RESULTADOS: Cuando la infección llega al feto, se despliega una respuesta proinflamatoria con secreción de citocinas, que son la base para el diagnóstico de síndrome de respuesta inflamatoria fetal. Cuando esta respuesta a la infección es desregulada, termina por generar un daño multiorgánico que puede ser reconocido por medio de herramientas no invasivas, como el ultrasonido fetal avanzado. Este reconocimiento permite iniciar la atención oportuna a fin de reducir las tasas de morbilidad y mortalidad perinatal. CONCLUSIÓN: La infección microbiana de la cavidad amniótica y del feto, con la generación subsecuente del síndrome de respuesta inflamatoria fetal, se asocia con daño multiorgánico que puede reconocerse en el ultrasonido avanzado y lograr la atención óptima y mejores desenlaces perinatales.

Abstract OBJECTIVE: To provide the reader with ample and sufficient information about this syndrome, with emphasis on the recognition of fetal multiorgan damage, to provide tools to establish a timely diagnosis and reduce fetal and neonatal morbidity and mortality. METHODOLOGY: Retrospective study based on the search in PubMed, EBSCO and Ovid databases from 2016 to 2021 of review articles, original research, practice guidelines and protocols. In addition, classic articles and those corresponding to manual searches to achieve contextualization of the points discussed. RESULTS: When infection reaches the fetus, a proinflammatory response with cytokine secretion unfolds, which are the basis for the diagnosis of fetal inflammatory response syndrome. When this response to infection is deregulated, it ends up generating multiorgan damage that can be recognized by means of noninvasive tools, such as advanced fetal ultrasound. This recognition allows initiating timely care in order to reduce perinatal morbidity and mortality rates. CONCLUSION: Microbial infection of the amniotic cavity and fetus, with subsequent generation of fetal inflammatory response syndrome, is associated with multiorgan damage that can be recognized on advanced ultrasound and achieve optimal care and better perinatal outcomes.

Infección por listeria monocytogenes en el embarazo, asociado a desprendimiento de placenta y complicaciones perinatales: reporte de un caso / Listeria monocytogenes infection in pregnancy, associated with placental abruption and perinatal complications: case report

INTRODUCCIÓN la listeriosis, aunque es una infección infrecuente, debe ser considerada en pacientes inmunocomprometidos y gestantes, especialmente en aquellos que consumen alimentos crudos o productos lácteos no pasteurizados, lo que pone en riesgo a un gran número de mujeres embarazadas en países de habla hispana. Es importante que el médico considere su inclusión en los posibles diagnósticos diferenciales cuando la sospecha clínica lo amerite, lo que permitirá hacer un diagnóstico temprano y por lo tanto un tratamiento oportuno, evitando así las posibles complicaciones en el binomio madre-hijo. CASO CLÍNICO clínico multigestante, con embarazo de 33 + 5 semanas, que ingresó a una institución de alto nivel de complejidad en la ciudad de Medellín, Colombia, por síndrome febril asociado a sepsis obstétrica debido a infección intraamniótica por Listeria monocytogenes, que requirió cesárea de urgencia, en donde se evidenció un desprendimiento placentario del 100 % secundario al proceso infeccioso y asociado a complicaciones neonatales. CONCLUSIONES: el diagnóstico de listeriosis gestacional supone un reto clínico por su presentación inespecífica y baja incidencia. Sin embargo, las consecuencias obstétricas arrastran una gran morbilidad de la madre y morbi-mortalidad neonatal, lo que hace de suma importancia que el clínico lo tenga presente en su arsenal diagnóstico, ya que una vez diagnosticado, el tratamiento oportuno tiene desenlaces clínicos favorables.

INTRODUCTION: although listeriosis is a rare infection, it should be considered in immunocompromised patients and pregnancy, especially in those who consume raw food or unpasteurized dairy, which puts a large number of pregnant women in Hispanic countries at risk. It is of special importance for physicians to include listeriosis among possible diagnoses when clinical suspicion arises in order to timely treat it and thus avoid the complications that may occur in the mother-child binomial. CLINICAL CASE: a pregnant woman (33 + 5 weeks) with multiple gestations, was admitted to a high level of complexity institution in the city of Medellín, Colombia, presenting a febrile syndrome associated with obstetric sepsis due to intra-amniotic infection by Listeria monocytogenes, which required emergency cesarean section where a 100 % placental abruption was evidenced secondary to the infectious process and associated with neonatal complications. CONCLUSIONS: The diagnosis of gestational listeriosis is a clinical challenge due to its nonspecific presentation and low incidence. However, the obstetric consequences drag a great maternal morbidity and neonatal morbidity and mortality, which is why it is important for physicians to consider this in the diagnostic arsenal because once diagnosed, the appropriate treatment has favorable clinical outcomes.

Repercusión de la corioamnionitis como factor de riesgo en la sepsis materna y neonatal temprana / Impact of Chorioamnionitis as a risk factor in early neonatal and maternal sepsis / Impacto da coioamnionite como fator de risco nasepse materna e neonatal precoce

RESUMEN Introducción: se realiza una revisión bibliográfica sobre la repercusión de la corioamnionitis como factor de riesgo en la sepsis neonatal temprana para la madre y el neonato en el Hospital provincial Universitario Docente "Carlos M. de Céspedes" en Bayamo, Granma en los cinco primeros meses del año 2019. Objetivo: profundizar el conocimiento de este factor de riesgo, suetiopatogenia, factores predisponentes, diagnóstico clínico y de laboratorio, riesgos para la madre y repercusión en el recién nacido, su prevención y tratamiento. Métodos: se utilizaron libros de texto específicos de Medicina y se realizó la recopilación de artículos de Internet a través de buscadores como el Servicio de la Editorial Elsevier, Secretaría de Ciencia y Técnica de la Nación, LILACS, MEDLINE con la asistencia del buscador específico PUBMED, IMBIOMED, La Biblioteca Cochrane, SciELO. Resultados: su incidencia en los partos pretérmino es mayor que en las gestaciones a término. Representa una de las tres principales causas de infección antes de término del embarazo con membranas íntegras y en caso de rotura prematura de membranas. Conclusiones: la repercusión en la madre incluye el parto pretérmino, si cesárea (atonía uterina o hemorragia postparto, absceso pélvico, tromboembolismo y endometritis, sepsis puerperal y la infección del torrente sanguíneo, mientras que en el neonato la leucomalacia periventricular con la consiguiente hemorragia periventricular, la broncodisplasia pulmonar, enterocolitis necrotizante, parálisis cerebral y el retraso mental.

ABSTRACT Introduction: a bibliographical review on the impact of Chorioamnionitis as a risk factor in early neonatal sepsis for the mother and the newborn in the provincial University Hospital "Carlos M. de Céspedes" is carried out in Bayamo, Granma in the first five months of the year 2019. Objective: to deepen the knowledge of this risk factor, its pathogenesis, predisposing factors, clinical and laboratory diagnosis, risks to the mother and repercussion in the newborn, its prevention and treatment. Methods: medicine-specific textbooks were used and the collection of Internet articles was made through search engines such as the service of the Editorial Elsevier, Secretariat of Science and Technology of the nation, LILACS, MEDLINE with the assistance of Specific search engine PUBMED, imbiomed, the Cochrane Library, SciELO. Results: its incidence in preterm births is greater than in term gestations. It represents one of the three main causes of infection before the end of pregnancy with intact membranes and in case of premature rupture of membranes. Conclusion: the impact on the mother includes preterm delivery, if caesarean section (uterine sluggishness or postpartum hemorrhage, pelvic abscess, thromboembolism and endometritis, puerperal sepsis and bloodstream infection, while in the neonate the Periventricular periventricular with consequent periventricular hemorrhage, pulmonary broncodisplasia, necrotizing enterocolitis, cerebral palsy and mental retardation.

RESUMO Introdução: uma revisão bibliográfica é realizada sobre o impacto da coioamnionite como fator de risco na sepse neonatal precoce para mãe e recém-nascidos no Hospital Escolar Provincial "Carlos M. de Céspedes" em Bayamo, Granma nos primeiros cinco meses de 2019. Objetivo: aprofundar o conhecimento desse fator de risco, sua etiopatogeneia, fatores predisponderantes, diagnóstico clínico e laboratorial, riscos para a mãe e impacto sobre o recém-nascido, sua prevenção e tratamento. Métodos: foram utilizados livros didáticos específicos de Medicina e o recolhimento de artigosna Internet foi realizado por meio de mecanismos de busca como o Serviço de Publicação Elsevier, Secretaria de Ciência e Técnica da Nação, LILACS, MEDLINE com o auxílio do mecanismo de busca específico PUBMED, IMBIOMED, The Cochrane Library, SciELO. Resultados: sua incidência em partos prematuros é maior do que nas gestações a termo. Representa uma das três principais causas de infecção antes do fim da gravidez com membranas completas e em caso de ruptura prematura de membranas. Conclusões: o impacto sobre a mãe inclui nascimento prematuro, se cesariana (atonia uterina ou hemorragia pós-parto, abscesso pélvico, tromboembolismo e endometrite, sepse pós-parto e infecção por corrente sanguínea, enquanto na leucomalacia periventricular neonate com hemorrhagem periventricular consequente, broncododisplasia pulmonar, enterocolite necrosante, paralisia cerebral e retardo mental.

A study of maternal outcome in term premature rupture of membranes in a tertiary care hospital

Background: Premature rupture of membranes (PROM) remains a subject of great clinical relevance. The present study was conducted to study maternal morbidity and its relationship with PROM-delivery interval in patients with term PROM as compared to patients without PROM.Methods: A prospective case control study was conducted in the department of obstetrics and gynecology, Kasturba Hospital, New Delhi. 100 pregnant patients presenting to the labor room with features of PROM at term (POG>37 weeks) were taken as cases and 100 term pregnant women (age and parity matched) with intact membranes were taken as controls and compared in terms of maternal outcome.Results: This study reported maternal morbidity rate of 21% in term PROM cases which was significantly higher than in control group (5%). The major cause was febrile morbidity which occurred in 16% of cases indicating ascending infection. Other complications were abdominal and episiotomy wound infection (4%), chorioamnionitis (2%), postpartum hemorrhage (2%) and puerperal sepsis (1%). There was an increased rate of operative delivery in the case group (33%) as compared to 18% in patients without PROM. Duration of PROM-delivery interval had a significant direct proportional impact on the maternal morbidity. The duration of combined hospital stay of mother and neonate was also increased.Conclusions: Patients with term PROM have significant maternal morbidity which was mainly due to infection. The duration of the hospital stay was also significantly increased.

Riesgo de daño cerebral en prematuros menores de 34 semanas expuestos a corioamnionitis histológica, Lima, Perú / Risk of brain damage in premature infants under 34 weeks of gestational age exposed to histological chorioamnionitis Lima, Peru

RESUMEN Objetivos: Evaluar el riesgo de daño cerebral en prematuros menores de 34 semanas expuestos a corioamnionitis histológica (CAH). Materiales y métodos: Se realizó un estudio de cohortes en el Hospital Cayetano Heredia, durante el 2015. Fueron incluidos prematuros menores de 34 semanas que tuvieran examen histopatológico de la placenta. Los tipos de CAH evaluados fueron subcorionitis, corionitis, corioamnionitis, con o sin funisitis. El daño cerebral se evaluó en tres periodos de edad, entre 0 y 7 días, entre 7 y 30 días y a las 40 semanas gestacionales corregidas. Se realizó un seguimiento neurológico y controles con ecografía cerebral. Resultados: Se estudiaron 85 prematuros, 47,1% eran mujeres y la media de la edad gestacional fue de 30,9 semanas. El 42% (36/85) nacieron expuestos a CAH. La ruptura prematura de membrana fue la principal generatriz de sepsis, y la sepsis se relacionó con daño neurológico. La CAH estuvo asociada con hemorragia intraventricular (HIV) durante la primera semana y con lesiones de la sustancia blanca entre los 7 y 30 días de edad (p = 0,035). El tipo corioamnionitis de CAH se asoció al daño neurológico durante la primera semana (RR = 2,11; IC 95%: 1,09-4,11) y entre los 7 y 30 días de vida (RR = 2,72; IC 95%: 1,07-6,88). Conclusiones: La corioamnionitis fue un factor de riesgo para desarrollar lesiones cerebrales en prematuros menores de 34 semanas, para HIV durante los primeros 7 días y lesiones de sustancia blanca entre los 7 y los 30 días de edad. A las 40 semanas de edad corregida, los prematuros extremos con CAH tuvieron lesiones cerebrales más extensas.

ABSTRACT Objectives: To assess the risk of brain damage in premature infants under 34 weeks of gestational age exposed to histological chorioamnionitis (HCA). Materials and methods: A cohort study was conducted at the Hospital Cayetano Heredia, during 2015. Premature infants under 34 weeks of gestational age, who had histopathological examination of the placenta, were included. The types of HCA evaluated were sub-chorionitis, chorionitis, chorioamnionitis, with or without funisitis. Brain damage was evaluated in three age periods, between 0 and 7 days, between 7 and 30 days and at 40 weeks of corrected gestational age. A neurological follow-up and regular controls were performed with brain ultrasound. Results: A total of 85 premature infants were included, 47.1% were women and the mean gestational age was 30.9 weeks. From the total, 42% (36/85) were born exposed to HCA. Premature rupture of membranes was the main cause of sepsis, which was related to neurological damage. HCA was associated with intraventricular hemorrhage (IVH) during the first week and with white matter lesions between 7 and 30 days of age (p = 0.035). The chorioamnionitis type of HCA was associated with neurological damage during the first week (RR = 2.11, 95% CI: 1.09-4.11) and between 7 and 30 days of age (RR = 2.72, 95% CI: 1.07-6.88). Conclusions: Chorioamnionitis was a risk factor for developing brain injuries in premature infants under 34 weeks of gestational age. It was also a risk factor for HIV during the first 7 days and for white matter injuries between 7 and 30 days of age. At 40 weeks of corrected gestational age, extreme premature infants with HCA had more extensive brain damage.

Sepsis neonatal en embarazos a término con corioamnionitis clínica, utilidad de la escala de sepsis / Neonatal sepsis in pregnant at term with clinical chorioamnionitis, utility of sepsis score

RESUMEN Introducción: la corioamnionitis se presenta en 3 a 10 % de los embarazos a término, y los recién nacidos expuestos tienen el riesgo de desarrollar sepsis precoz. Objetivos: determinar la prevalencia de sepsis neonatal en hijos de embarazadas a término con corioamnionitis; describir las características clínicas de las madres y recién nacidos; y evaluar la utilidad de la escala de sepsis (escala de Rodwell y PCR) para el diagnóstico. Metodología: estudio observacional, descriptivo, de recién nacidos a término, producto de madres con corioamnionitis clínica, nacidos e internados en el Servicio de Neonatología del Hospital Nacional desde enero del 2013 a junio del 2016. Fueron excluidos los mortinatos, portadores de infecciones STORCH, y los que no tenían hemocultivo. Resultados: reunieron criterios de inclusión 71 neonatos a término. La población materna estuvo conformada por adolescentes y adultas jóvenes en 98,5 %, nulíparas y primíparas en 94 %, la rotura de membranas fue >18 horas en 34 (47,8 %) y el nacimiento se efectuó por cesárea en 24 (35,2 %). Los motivos de cesárea han sido la dilatación estacionaria y el sufrimiento fetal agudo en 17 (69,8 %). Desarrollaron sepsis neonatal 11 (15,4 %), 3 fueron confirmados con hemocultivo positivo, 10 presentaron síntomas y 7 depresión al nacer. Ninguno falleció. La primera escala de sepsis efectuada en 3,8 ± 1,8 horas de vida, y la segunda en una mediana de 45,5 horas, tuvieron un valor predictivo positivo de 50 % y 60 %. El valor predictivo negativo fue de 85 y 87 % respectivamente. Conclusión: la sepsis neonatal se presentó en 15,4 %. Casi todos fueron sintomáticos y presentaron depresión al nacer. La escala de sepsis no fue útil para confirmar el diagnóstico, sí para descartarla.

ABSTRACT Introduction: chorioamnionitis occurs in 3 to 10 % of full-term pregnancies, and newborns are at risk of developing early sepsis. Objectives: to determine the prevalence of neonatal sepsis in children of term pregnant women with chorioamnionitis; describe the clinical characteristics of mothers and newborns; and evaluate the utility of the sepsis scale (Rodwell scale and PCR) for diagnosis. Methodology: descriptive study, of term newborns, product of mothers with clinical chorioamnionitis, born and admitted to the Servicio de Neonatología del Hospital Nacional from January 2013 to June 2016. Stillbirths, carriers of STORCH infections, and they had no blood culture. Results: 71 term infants met inclusion criteria. The maternal population was made up of adolescents and young adults in 98,5 %, nulliparous and prim parous in 94 %, membrane rupture was >18 hours in 34 (47,8 %) and the birth was performed by caesarean section in 24 (35, 2 %). The reasons for cesarean section were stationary dilation and acute fetal distress in 17 (69,8 %). Neonatal sepsis developed 11 (15,4 %), 3 were confirmed with a positive blood culture, 10 symptoms and 7 depression at birth. Neither died. The first sepsis scale performed at 3,8 ± 1,8 hours of life, and the second at a median of 45,5 hours, had a positive predictive value of 50 % and 60 %. The negative predictive value was 85 and 87 % respectively. Conclusion: neonatal sepsis presented in 15,4 %. Almost all were symptomatic and depressed at birth. The sepsis scale was not useful to confirm the diagnosis, but to rule it out.

Chorioamnionitis: Establishing a correlation between clinical and histological diagnosis

Introduction: Chorioamnionitis that is associated with high rates of morbidity and mortality needs an early diagnosis for effective treatment. However, views are conflicting on the effectiveness of a clinical versus a histological diagnosis of the disease. The accuracy of clinical diagnoses should be evaluated by determining their correlation with histopathological data. Methods: A total of 696 placental records from single and multiple pregnancies between January 2011 and February 2018 were collected and reviewed to determine if chorioamnionitis was present. Results: Of the 696 records, 255 had histological data available, and of these, histological evidence for chorioamnionitis was recorded in 135 (52.9%). Clinical chorioamnionitis diagnosis was insensitive (26.7%; 95% confidence interval 19.43%–34.96%) and inaccurate (61.1%; 95% confidence interval 54.90%–67.19%). As well, 73.3% of histologically positive chorioamnionitis cases were missed using clinical indicators. Discussion: Clinical diagnosis for chorioamnionitis is inaccurate; in our study, most of the positive cases were not diagnosed using clinical indicators. However, of the clinical indicators examined, maternal and fetal tachycardia were the most reliable.

Study of fetomaternal outcome in cases of premature rupture of membrane at tertiary care rural institute of Western Uttar Pradesh, India

Background: Premature rupture of membranes (PROM) is the rupture of the fetal membranes before the onset of labor. Preterm PROM complicates approximately 3 percent of pregnancies and leads to one third of preterm births. It increases the risk of prematurity and leads to a number of other perinatal and neonatal complications.Methods: This was a prospective study carried out at the department of obstetrics and gynaecology, UPUMS, Saifai from April 2018 to September 2018 (6 months study). Patients with Spontaneous rupture of membranes any time beyond 28th week of pregnancy, but before the onset of labour. Patients with following conditions were excluded from the study- meconium stain liquor, cord prolapse, antepartum haemorrhage, active infection at other sites, active liver disease.Results: A total of 103 cases of premature rupture of membrane (PROM) were recorded from April 2018 to September 2019 among 1523 admitted pregnant patients. Most of the patients 56 (54.36%) were delivered by caesarean section (C/S). Previous C/S, oligohydramnios, fetal distress, chorioamnionitis were the common indications for doing C/S. Forty-seven (45.63%) patients were delivered vaginally.Conclusions: Most of the affected women belongs to 20-24 years of age (53.39%). Term PROM was more in comparison to PPROM and most of them were multigravidae. Cesarean section rate was high. Most common complication was of subclinical urogenital infection (51.02%).

Analysis of high risk factors in 263 very premature infants complicated with bronchopulmonary dysplasia / 中国基层医药

Objective To analyze the clinical risk factors of bronchopulmonary dysplasia (BPD) in very premature infants and provide reference for the prevention and treatment of BPD in order to improve the prognosis of premature infants.Methods From January 2015 to December 2017,263 very premature infants(referring to premature infants with gestational age between 28 weeks and 32 weeks) in the neonatology department of the Maternal and Child Health Care Hospital Affiliated to Anhui Medical University were selected .They were divided into BPD group(108 cases) and non-BPD group(155 cases) according to the diagnostic criteria of BPD .The clinical data of the patients and the hospitalized patients were retrospectively investigated .The general conditions of the very premature infants in the two groups were compared.The clinical risk factors for BPDin very premature infants were analyzed.Results There were 263 very preterm infants included in the study ,108 cases in the BPD group,the incidence was 41.1％.The data analysis showed that BPD occurred in premature infants with sex (χ2 =4.311),gestational age(Z=-6.544),birth weight(t=-5.382),maternal chorioamnionitis(χ2 =4.946),neonatal respiratory distress syndrome (χ2 =25.424), anemia(χ2 =22.443),multiple blood transfusion(Z=-8.101),mechanical ventilation time greater than 7 days (χ2 =10.946),high oxygen concentration (χ2 =25.028),the differences were statistically significant (all P<0.05). The multivariate logistic regression analysis suggested that gestational age (OR=1.478,95％ CI:1.140-1.914), maternal pregnancy with chorioamnionitis (OR=0.152,95％CI:0.029-0.797),maximum oxygen concentration >40％(OR=0.261,95％CI:0.136-0.502),number of blood transfusions (OR=0.582,95％ CI:0.456-0.742) were independent risk factors for BPD in preterm infants.Conclusion There are many factors leading to BPD in premature infants,including maternal comorbidities and neonatal factors ,and its pathogenesis is complex and diverse . It is necessary to further study these related factors ,timely intervention ,strengthen maternal health care ,and minimize risk factors,thus to reduce the incidence of BPD ,improve the prognosis of premature infants .

Analysis of high risk factors in 263 very premature infants complicated with bronchopulmonary dysplasia / 中国基层医药

Objective@#To analyze the clinical risk factors of bronchopulmonary dysplasia(BPD) in very premature infants and provide reference for the prevention and treatment of BPD in order to improve the prognosis of premature infants.@*Methods@#From January 2015 to December 2017, 263 very premature infants(referring to premature infants with gestational age between 28 weeks and 32 weeks) in the neonatology department of the Maternal and Child Health Care Hospital Affiliated to Anhui Medical University were selected.They were divided into BPD group(108 cases) and non-BPD group(155 cases) according to the diagnostic criteria of BPD.The clinical data of the patients and the hospitalized patients were retrospectively investigated.The general conditions of the very premature infants in the two groups were compared.The clinical risk factors for BPD in very premature infants were analyzed.@*Results@#There were 263 very preterm infants included in the study, 108 cases in the BPD group, the incidence was 41.1%.The data analysis showed that BPD occurred in premature infants with sex(χ2=4.311), gestational age(Z=-6.544), birth weight(t=-5.382), maternal chorioamnionitis(χ2=4.946), neonatal respiratory distress syndrome(χ2=25.424), anemia(χ2=22.443), multiple blood transfusion(Z=-8.101), mechanical ventilation time greater than 7 days(χ2=10.946), high oxygen concentration(χ2=25.028), the differences were statistically significant(all P<0.05). The multivariate logistic regression analysis suggested that gestational age(OR=1.478, 95% CI: 1.140-1.914), maternal pregnancy with chorioamnionitis (OR=0.152, 95% CI: 0.029-0.797), maximum oxygen concentration>40%(OR=0.261, 95% CI: 0.136-0.502), number of blood transfusions(OR=0.582, 95% CI: 0.456-0.742) were independent risk factors for BPD in preterm infants.@*Conclusion@#There are many factors leading to BPD in premature infants, including maternal comorbidities and neonatal factors, and its pathogenesis is complex and diverse.It is necessary to further study these related factors, timely intervention, strengthen maternal health care, and minimize risk factors, thus to reduce the incidence of BPD, improve the prognosis of premature infants.

Subsequent pregnancy outcomes according to the presence of acute histologic chorioamnionitis in women with spontaneous preterm delivery

OBJECTIVE: To compare subsequent pregnancy outcomes according to the presence of acute histologic chorioamnionitis (HCA) in women with spontaneous preterm delivery (SPTD).METHODS: Among 1,706 women who gave birth twice or more at our institution, 138 women delivered spontaneously at preterm (<37.0 weeks). Subsequent deliveries occurred at our institution and placental biopsy results were available. The study population was categorized into 2 groups based on the presence of acute HCA at the time of SPTD: HCA group (n=52) and non-HCA group (n=86). The primary outcome measures were gestational age at delivery, birthweight, and frequency of preterm delivery in subsequent pregnancies.RESULTS: The median gestational age at the time of SPTD was 34.0 weeks (interquartile range [IQR], 28.9–35.3 weeks), and the frequency of acute HCA was 52/138 (38%). There were no differences in gestational age at delivery, birthweight, and frequency of preterm delivery between the HCA group and non-HCA group (median gestational age at delivery, 38.0 weeks (IQR, 36.7–38.8 weeks) in the HCA group vs. 37.9 weeks (IQR, 35.7–39.0 weeks) in the non-HCA group; frequency of preterm delivery, 14/52 (27%) in the HCA group vs. 33/86 (38%) in the non-HCA group; and median birthweight, 3.14 kg (IQR, 2.64–3.45 kg) in the HCA group vs. 2.95 kg (IQR, 2.44–3.36 kg) in the non-HCA group; P>0.1 for all.CONCLUSION: The presence of acute HCA in women at prior SPTD did not significantly affect their subsequent pregnancy outcomes.

Complicaciones neonatales asociadas al diagnóstico de corioamnionitis histológica en pacientes con parto pretérmino espontáneo en un hospital de alta complejidad en Colombia / Neonatal complications associated with the diagnosis of histological chorioamnionitis in patients with spontaneous preterm delivery in a highly complexity hospital in Colombia

INTRODUCCIÓN: La corioamnionitis histológica (CH) es causa importante de parto pretérmino y se asocia a resultados neonatales adversos, con secuelas del neurodesarrollo. Ocurre en alrededor de un 20% de embarazos a término y 60% de pretérmino. Este proceso está asociado a varias complicaciones neonatales, entre las más frecuentes: sepsis neonatal temprana, menor edad gestacional y mayor estancia hospitalaria. OBJETIVO: Establecer la asociación de complicaciones neonatales con el diagnóstico de CH en pacientes con parto pretérmino espontáneo en un hospital de alta complejidad. MÉTODOS: Estudio retrospectivo, se incluyeron 160 pacientes con parto pretérmino espontáneo con estudio histopatológico de la placenta según protocolo institucional. Se recolectan las características basales de la gestante y complicaciones neonatales. Se calcula la prevalencia de CH, y se comparan dos grupos (con y sin) la asociación de complicaciones neonatales, distribuidas por edad gestacional y peso neonatal. RESULTADOS: La prevalencia de CH es de 69% (IC95%: 61-76). Al distribuir por edad gestacional se reporta: 87% en 34 (IC 95%: 45 -67). La CH entre las 28 - 34 y > 34 semanas, se asocia a mayor sepsis neonatal temprana (p 2000 g se asocia con sepsis neonatal (p<0.05). CONCLUSIÓN: La prevalencia de CH es alta, principalmente a menor edad gestacional, se asocia a complicaciones neonatales como la sepsis neonatal temprana.

INTRODUCTION: Histological chorioamnionitis (HC) is an important cause of preterm delivery and is associated with adverse neonatal outcomes, with sequelae of neurodevelopment. It occurs in about 20% of full-term and 60% preterm pregnancies. This process is associated with several neonatal complications, among the most frequent: early neonatal sepsis, younger gestational age, and longer hospital stay. OBJECTIVE: To establish the association of neonatal complications with HC diagnosis in patients with spontaneous preterm delivery in a highly complexity hospital in Colombia. RESULTS: The prevalence of HC is 69% (95% CI: 61-76). When distributed by gestational age, it is reported: 87% in 34 (95% CI: 45-67). HC between 28 - 34 and > 34 weeks, is associated with higher early neonatal sepsis (p 2000 g is associated with early neonatal sepsis (p <0.05). CONCLUSION: The prevalence of HC is high, mainly at a lower gestational age, it is associated with neonatal complications such as early neonatal sepsis.

¿Se puede prevenir el parto prematuro por infección bacteriana ascendente y sus resultados adversos en los hospitales públicos de Chile? / Can preterm birth be prevented from ascending bacterial infection and its adverse results in the public hospitals of Chile?

Resumen El parto prematuro (PP) es el principal contribuyente de la morbilidad/mortalidad perinatal. A pesar del conocimiento de los factores de riesgo y de la introducción de intervenciones médicas destinadas a la prevención del nacimiento prematuro, su frecuencia ha aumentado. La infección bacteriana ascendente (IBA) es la condición obstétrica más frecuente asociada al PP ocasionando un importante resultado perinatal adverso en un hospital público de Chile. Esta revisión muestra la asociación entre PP e IBA, analiza la fisiopatología y la inmunología de las infecciones vaginales en la mujer embarazada susceptible, como asimismo la aplicación en este grupo de medidas con evidencia clínica que han demostrado ser eficientes, tales como la pesquisa rutinaria y el tratamiento de las infecciones genitourinarias (IGU), el cerclaje profiláctico o terapéutico, uso de probióticos, de progesterona vaginal, control metabólico de la diabetes mellitus y del peso de la obesa. El tratamiento de las IGU, conjuntamente con el uso de intervenciones que mejoran la inmunidad vaginal en la población de riesgo, permiten predecir una reducción del PP por IBA, de sus consecuencias inmediatas y de largo plazo y costos asociados elevados, con el consiguiente beneficio de la salud pública de Chile.

Preterm birth (PB) is the main contributor to the perinatal morbidity/mortality. In spite of the knowledge of the risk factors and the introduction of medical interventions intended to prevent PB, its frequency has increased. Ascending bacterial infection (ABI) is the obstetric condition most frequently associated to PB causing an important adverse perinatal outcome in a public hospital in Chile. This review shows the association between PB and ABI, analyzes the physiopathology and immunology of vaginal infections in the susceptible pregnant woman., as well as their application in this group of effective measures demonstrated by evidence, such as routine control, treatment of genitourinary tract infections (GTI), prophylactic or therapeutic cerclage, use of probiotics, use of vaginal progesterone, metabolic control of diabetes mellitus and weight of the obese woman. Treatment GTI together with the use of medical interventions that improve the vaginal immunity in the risk population allow to predict a reduction of PB by ABI and of its immediate consequences, long term sequels and high associated costs, with the consequent benefit of the public health in Chile.

Procalcitonina, como predictor subclínico de corioamnionitis / Procalcitonin, as subclinic predictor of corioamnionitis

OBJETIVOS: determinar la importancia de la Procalcitonina sérica como predictor subclínico de Corioamnionitis en pacientes con Ruptura prematura de membranas, en el Hospital Materno Infantil German Urquidi. MÉTODOS: al no haber estudios sobre procalcitonina sérica en el diagnóstico precoz de corioamnionitis subclínica, este estudio está enmarcada en un enfoque cuasiexperimental y prospectivo; se incluyeron a 85 pacientes a partir de una población de 280 que ingresaron con diagnóstico de Ruptura Prematura de Membranas de 28 a 32 semanas de gestación en el Hospital Materno Infantil German Urquidi, de abril 2017 a febrero 2018. Se hizo una revisión documentada, validación de formulario, recolección de datos, determinación de procalcitonina sérica seriada, utilizándose como prueba de contraste los criterios de Gibss, procediéndose con análisis de datos, conclusiones y recomendaciones. RESULTADOS: entre el día 2 a 8 de RPM un promedio 10,53% de la población estudiada, no teniendo datos clínicos de corioamnionitis presento resultados de procalcitonina sérica mayor a 0,5 ng/ml considerándose positiva sugerente de infección. Se evidencio, diferencias estadísticas significativas relativas con un incremento paulatino de los indicadores clínicos principalmente en los días 5 y 8 en un 10,5 % y 16,4% respectivamente; haciendo referencia que la Procalcitonina parece ser un marcador competente precoz de infección. Se pudo establecer para la procalcitonina sérica en el diagnóstico de corioamnionitis subclínica, una sensibilidad del 72 %, una especificidad de 66.6%, un valor predictivo positivo del 62%, un valor predictivo negativo del 36,9%, cuando se aplica entre el día 2 a 8 de RPM. CONCLUSIONES: la procalcitonina sérica debería ser tomado en cuenta como una alternativa diagnostica de Corioamnionitis subclínica para tomar conductas oportunas.

OBJECTIVES: to determine the importance of serum procalcitonin as a subclinical predictor of chorioamnionitis in patients with premature rupture of membranes at the German Urquidi Maternal and Child Hospital. METHODS: in the absence of studies on serum procalcitonin in the early diagnosis of subclinical chorioamnionitis, this study is framed in a quasi-experimental and prospective approach; We included 85 patients from a population of 280 who were admitted with a diagnosis of Premature Membrane Rupture from 28 to 32 weeks of gestation in the German Urquidi Maternal and Child Hospital, from April 2017 to February 2018. A documented review, form validation, data collection, determination of serial serum procalcitonin was performed, using the Gibss criteria as a contrast test, proceeding with data analysis, conclusions and recommendations. Results: between day 2 to 8 of RPM, an average of 10.53% of the studied population, not having clinical data of chorioamnionitis, showed results of serum procalcitonin greater than 0.5 ng / ml, considering itself positive suggestive of infection. It was evidenced, significant statistical differences with a gradual increase of the clinical indicators mainly on days 5 and 8 in 10.5% and 16.4% respectively; making reference that procalcitonin seems to be a competent early marker of infection. It was possible to establish for serum procalcitonin in the diagnosis of subclinical chorioamnionitis, a sensitivity of 72%, a specificity of 66.6%, a positive predictive value of 62%, a negative predictive value of 36.9%, when applied between days 2 to 8 of RPM. CONCLUSIONS: procalcitonin serum should be taken into account as a diagnostic alternative of subclinical chorioamnionitis to take timely behaviors.