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Chorioamnionitis And Neonatal Sepsis

Carlo Pietrasanta, Lorenza Pugni, Daniela Merlo, Barbara Acaia, Dario Consonni, Andrea Ronchi, Manuela Wally Ossola, Beatrice Ghirardi, Ilaria Bottino, Fulvia Milena Cribiù, Silvano Bosari, Fabio Mosca
OBJECTIVE: To investigate the impact of different stages of intrauterine inflammation (IUI) on neonatal outcomes, before and after adjusting for gestational age (GA) and other perinatal confounders. METHODS: This was an observational, prospective, single-center cohort study including all eligible neonates with GA < 35 weeks and/or birth weight ≤ 1500 g born at a 3rd level Neonatal Intensive Care Unit between 2011 and 2014. Pathological patterns of placenta, membranes and cord were classified according to Redline's criteria...
2019: PloS One
Kartik K Venkatesh, Wesley Jackson, Brenna L Hughes, Mathew M Laughon, John M Thorp, David M Stamilio
OBJECTIVE: To investigate the association of chorioamnionitis, and secondarily its duration, on neonatal adverse outcomes for infants born <34 weeks vs. ≥34 weeks. STUDY DESIGN: A secondary analyss from the observational U.S. Consortium on Safe Labor Study. The exposure was chorioamnionitis, and secondarily, its estimated duration. The composite outcome included pneumonia, seizure, necrotizing enterocolitis, sepsis, periventricular/intraventricular/cerebral hemorrhage, mechanical ventilation, and neonatal death...
February 5, 2019: Journal of Perinatology: Official Journal of the California Perinatal Association
Ufuk Çakir, Duran Yildiz, Dilek Kahvecioğlu, Emel Okulu, Serdar Alan, Ömer Erdeve, Aylin Okçu Heper, Begüm Atasay, Saadet Arsan
OBJECTIVE: The microscopic and macroscopic features of the placenta can contribute to the clinical understanding of premature delivery. The aim of our study was to figure out the relationship between the histopathological findings of the placentas of premature deliveries and its effects on neonatal morbidity and mortality. MATERIAL AND METHOD: The placentas of 284 singleton preterm infants with < 35 weeks of gestation were examined. Three groups were created as the normal, chorioamnionitis and vasculopathy groups according to the histopathological findings in the placentas of the subjects...
2019: Türk Patoloji Dergisi
Jennifer Bermick, Katherine Gallagher, Aaron denDekker, Steve Kunkel, Nicholas Lukacs, Matthew Schaller
Chorioamnionitis is an intrauterine infection involving inflammation of the chorion, amnion and placenta. It leads to a fetal systemic inflammatory response that can alter the transcription of neonatal immune genes. We have previously shown that neonatal monocytes gain the activating histone tail modification H3K4me3 at promoters of immunologically important genes as development progresses from preterm neonate to adult. In this study, we applied ChIP-seq and RNA-seq to evaluate the impact of chorioamnionitis on the neonatal monocyte H3K4me3 histone modification landscape over the course of fetal and neonatal immune system development...
December 18, 2018: FEBS Journal
Tara A Lynch, Courtney Olson-Chen, Sarah Colihan, Jeffrey Meyers, Conisha Holloman, Dongmei Li, Heather Link, Paola Torres, Annie Kim, Devon J King, Cari Eckman, Anna Varlamov, Scott Dexter, Eva K Pressman, Eleazar Soto-Torres, Amol Malshe
OBJECTIVE:  To evaluate outcomes with expectant management of preterm prelabor rupture of membranes (PROM) until 35 weeks versus immediate delivery at ≥34 weeks. STUDY DESIGN:  This was a multicenter retrospective cohort study of singletons with preterm PROM at >20 weeks from 2011 through 2017. Groups were defined as expectant management until 35 weeks versus immediate delivery at ≥34 weeks. Primary outcome was composite neonatal morbidity: need for respiratory support, culture positive neonatal sepsis, or antibiotic administration for >72 hours...
December 15, 2018: American Journal of Perinatology
Jean-Charles Pasquier, Olivier Claris, Muriel Rabilloud, René Ecochard, Jean-Charles Picaud, Stéphanie Moret, Danielle Buch, Georges Mellier
OBJECTIVES: Preterm premature rupture of fetal membranes (PPROM) exposes the fetus to preterm birth, and optimal timing for delivery is controversial. The aim of this study was to compare intentional early delivery ("active management") with expectant management in very preterm birth (28-32 weeks). STUDY DESIGN: We conducted a prospective randomized controlled trial with intent-to-treat analysis, at 19 tertiary-care hospitals in France and 1 in Geneva, Switzerland...
February 2019: European Journal of Obstetrics, Gynecology, and Reproductive Biology
Noémia Rosado Silva, Joana Oliveira, Alberto Berenguer, André M Graça, Margarida Abrantes, Carlos Moniz
INTRODUCTION: Prematurity and low birth weight have been associated with increased neonatal morbidity and mortality. This study aimed to evaluate possible risk factors for prematurity associated with fetal growth restriction and being small for gestational age and to determine the incidence of morbidity in these two groups of infants. MATERIAL AND METHODS: Retrospective case-control study of newborns with gestational age of less than 32 weeks, with obstetric diagnosis of fetal growth restriction and with the clinical diagnosis of small for gestational age, admitted to the Neonatal Intensive Care Unit of a tertiary hospital for a period of six years...
November 30, 2018: Acta Médica Portuguesa
Fábio Gonçalves Coutinho, Edna Maria de Albuquerque Diniz, Ingrid Kandler, Marco Antônio Cianciarullo, Natália Rodrigues Dos Santos
BACKGROUND: To determine the concentration of the Lipid Peroxidation Marker: Malondialdehyde (MDA), and Antioxidant Markers: Superoxide Dismutase (SOD), Glutathione Peroxidase (GPX), Catalase (CAL) in umbilical cord blood and in unstimulated saliva in the first 24 and 48 hours of life in the PTNB of mothers with and without risk factors for early-onset neonatal sepsis. METHODS: Cross-sectional study with the signing of informed consent by the pregnant women and application of a standard questionnaire classifying the PTNB in Group 1 or 2...
October 2018: Revista da Associação Médica Brasileira
Unzila Ali Nayeri, Catalin S Buhimschi, Guomao Zhao, Irina A Buhimschi, Vineet Bhandari
We aimed to test the hypothesis that determinants of the perinatal clinical exposome related to the underlying etiology of premature birth (PTB) impact differently on select neonatal outcomes. We conducted a prospective longitudinal study of 377 singleton preterm neonates [gestational age (GA) at birth: 23-34 weeks] separated into three distinct contemporaneous newborn cohorts: i) spontaneous PTB in the setting of intra-amniotic infection/inflammation (yes-IAI, n = 116); ii) spontaneous PTB in the absence of IAI (no-IAI, n = 130), and iii) iatrogenic PTB for preeclampsia (iPTB-PE, n = 131)...
2018: PloS One
Ryan S Doster, Jessica A Sutton, Lisa M Rogers, David M Aronoff, Jennifer A Gaddy
Streptococcus agalactiae , or group B Streptococcus (GBS), is a common perinatal pathogen. GBS colonization of the vaginal mucosa during pregnancy is a risk factor for invasive infection of the fetal membranes (chorioamnionitis) and its consequences such as membrane rupture, preterm labor, stillbirth, and neonatal sepsis. Placental macrophages, or Hofbauer cells, are fetally derived macrophages present within placental and fetal membrane tissues that perform vital functions for fetal and placental development, including supporting angiogenesis, tissue remodeling, and regulation of maternal-fetal tolerance...
November 20, 2018: MBio
Pawel T Schubert, Deidre Mason, Roosacelis Martines, Marlene Deleon-Carnes, Sherif R Zaki, Drucilla J Roberts
Fetal bacterial infections are a common cause of fetal/neonatal morbidity and mortality. The pathologic correlates of congenital bacterial infection include acute chorioamnionitis, acute villitis, and acute intervillositis. The strength of the association of congenital bacterial infection differs among these pathologies. Acute chorioamnionitis results usually from an ascending infection, and damage to the fetus is thought to be cytokine driven rather than damage secondary to bacteremia. Acute villitis is strongly associated with fetal sepsis due to congenital infections...
October 18, 2018: Pediatric and Developmental Pathology
Kavitha Abraham, Elsy Thomas, Jessie Lionel
Purpose of study: To assess the maternal and perinatal complications associated with meconium-stained amniotic fluid (MSAF) in low-risk women in labor. Methods: This prospective cohort study was conducted at CMC Hospital, Vellore, India. Two hundred low-risk women who had artificial or spontaneous rupture of membranes after admission with MSAF were included in the study. Two hundred similar women with clear liquor were taken as controls. The primary outcomes considered were the incidence of chorioamnionitis and endomyometritis in the mothers...
October 2018: Journal of Obstetrics and Gynaecology of India
Ladawna L Gievers, Jennifer Sedler, Carrie A Phillipi, Dmitry Dukhovny, Jonah Geddes, Peter Graven, Benjamin Chan, Sheevaun Khaki
BACKGROUND: To prevent early onset sepsis (EOS), ~10% of neonates receive antibiotics based on CDC recommendations regarding chorioamnionitis exposure. A sepsis risk score (SRS) predicts EOS and spares unnecessary evaluation and treatment. LOCAL PROBLEM: Chorioamnionitis-exposed neonates utilize significant resources. METHODS: An SRS algorithm was implemented to decrease resource utilization in chorioamnionitis-exposed neonates ≥35 weeks'...
November 2018: Journal of Perinatology: Official Journal of the California Perinatal Association
Marina Ayrapetyan, David Carola, Satyan Lakshminrusimha, Vineet Bhandari, Zubair H Aghai
OBJECTIVE:  To evaluate variations in practice for the management of neonates born to mothers with clinical chorioamnionitis. METHODS:  This was a prospective cross-sectional survey consisting of 10 multiple choice questionnaires distributed to 2,900 members of the Perinatal Section of American Academy of Pediatrics. Variations in responses were assessed and compared between the various groups. RESULTS:  A total of 682 members (23.5%) completed the survey; 169 (24...
August 21, 2018: American Journal of Perinatology
Nafiseh Saghafi, Leila Pourali, Kiarash Ghazvini, Asieh Maleki, Mahdis Ghavidel, Mohsen Karbalaeizadeh Babaki
Background: One of the most important etiologies in pretermpremature rupture of membranes (PPROM) is cervical bacterial colonization. Objective: This study evaluated cervical bacterial colonization in women with PPROM and the pregnancy outcomes. Materials and Methods: In this cohort study, 200 pregnant women with PPROM at 27-37 wk of gestation who were admitted in an academic hospital of Mashhad University of Medical Sciences from March 2015 to July 2016 were studied...
May 2018: International Journal of Reproductive Biomedicine (Yazd, Iran)
Elias Merdassa Roro, Mitike Molla Sisay, Lynn M Sibley
BACKGROUND: Statistics indicate that Ethiopia has made remarkable progress in reducing child mortality. It is however estimated that there is high rate of perinatal mortality although there is scarcity of data due to a lack of vital registration in the country. This study was conducted with the purpose of assessing the determinants and causes of perinatal mortality among babies born from cohorts of pregnant women in three selected districts of North Showa Zone, Oromia Region, Ethiopia...
July 18, 2018: BMC Public Health
Carlos Fajardo, Belal Alshaikh, Andrei Harabor
BACKGROUND: Most preterm infants are exposed to a variable duration of antibiotic therapy after birth despite negative cultures. Data is emerging about the risks of prolonged antibiotics. We sought to assess the association between length of initial antibiotic course and neonatal outcomes in a cohort from a single large perinatal center. METHODS: Retrospective cohort study of prospectively collected data on all infants with a birth weight of less than 1250 g hospitalized in our NICU in a 4 year window and who had negative blood and CSF cultures in the first 2 days of life...
June 12, 2018: Journal of Maternal-fetal & Neonatal Medicine
Sara Pinto, Maria Filipa Malheiro, Ana Vaz, Teresa Rodrigues, Nuno Montenegro, Hercília Guimarães
PURPOSE: To evaluate neonatal outcomes in preterm infants with less than 34 weeks after spontaneous labor, preterm premature rupture of membranes (PPROM) or iatrogenic delivery and to clarify whether the mechanism of labor onset is a risk factor for adverse short-term neonatal outcome. METHODS: We performed a retrospective case-control study, which included 266 preterm newborns with less than 34-week gestation, between 2011 and 2015. Neonatal outcomes were compared according to the mechanism of labor onset...
June 21, 2018: Journal of Maternal-fetal & Neonatal Medicine
Tara M Randis, Madeline Murguia Rice, Leslie Myatt, Alan T N Tita, Kenneth J Leveno, Uma M Reddy, Michael W Varner, John M Thorp, Brian M Mercer, Mara J Dinsmoor, Susan M Ramin, Marshall W Carpenter, Philip Samuels, Anthony Sciscione, Jorge E Tolosa, George Saade, Yoram Sorokin
Objective To determine the frequency of sepsis and other adverse neonatal outcomes in women with a clinical diagnosis of chorioamnionitis. Methods We performed a secondary analysis of a multi-center placebo-controlled trial of vitamins C/E to prevent preeclampsia in low risk nulliparous women. Clinical chorioamnionitis was defined as either the "clinical diagnosis" of chorioamnionitis or antibiotic administration during labor because of an elevated temperature or uterine tenderness in the absence of another cause...
October 25, 2018: Journal of Perinatal Medicine
Daniel Martingano, Audrey Renson, Sharon Rogoff, Shailini Singh, Meera Kesavan Nasir, Juliette Kim, Jeanne Carey
BACKGROUND: Clinical chorioamnionitis complicates approximately 1-4% of pregnancies overall. Although universal agreement does not exist regarding the antibiotic regimen of choice, most studies have evaluated intravenous ampicillin dosed at 2 g every 6 hours plus gentamicin dosed every 8 hours. Only three studies have examined daily gentamicin for the treatment of intrapartum chorioamnionitis and thus is insufficiently investigated. OBJECTIVE: This study seeks to determine whether daily dosing of gentamicin using ideal body weight for the treatment of intrapartum chorioamnionitis is more or equivalently efficacious when compared to traditional 8-hour dosing regimens...
April 12, 2018: Journal of Maternal-fetal & Neonatal Medicine
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