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Clinical Monitoring of Well-Appearing Infants Born to Mothers With Chorioamnionitis.

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Title: Clinical Monitoring of Well-Appearing Infants Born to Mothers With Chorioamnionitis.
Authors: Joshi, Neha S., Gupta, Arun, Allan, Jessica M., Cohen, Ronald S., Aby, Janelle L., Weldon, Brittany, Kim, Juliann L., Benitz, William E., Frymoyer, Adam
Source: Pediatrics. Apr2018, Vol. 141 Issue 4, p1-8. 10p.
Subjects: Inappropriate prescribing (Medicine), Hospitals, Antibiotics, Fetal diseases, Sepsis, Antibiotic prophylaxis, Children, Pregnancy, Prevention, Disease risk factors
Geographic Terms: United States
Abstract: BACKGROUND: The risk of early-onset sepsis is low in well-appearing late-preterm and term infants even in the setting of chorioamnionitis. The empirical antibiotic strategies for chorioamnionitis-exposed infants that are recommended by national guidelines result in antibiotic exposure for numerous well-appearing, uninfected infants. We aimed to reduce unnecessary antibiotic use in chorioamnionitis-exposed infants through the implementation of a treatment approach that focused on clinical presentation to determine the need for antibiotics. METHODS: Within a quality-improvement framework, a new treatment approach was implemented in March 2015. Well-appearing late-preterm and term infants who were exposed to chorioamnionitis were clinically monitored for at least 24 hours in a level II nursery; those who remained well appearing received no laboratory testing or antibiotics and were transferred to the level I nursery or discharged from the hospital. Newborns who became symptomatic were further evaluated and/or treated with antibiotics. Antibiotic use, laboratory testing, culture results, and clinical outcomes were collected. RESULTS: Among 277 well-appearing, chorioamnionitis-exposed infants, 32 (11.6%) received antibiotics during the first 15 months of the quality-improvement initiative. No cases of culture result-positive early-onset sepsis occurred. No infant required intubation or inotropic support. Only 48 of 277 (17%) patients had sepsis laboratory testing. The implementation of the new approach was associated with a 55% reduction (95% confidence interval 40%-65%) in antibiotic exposure across all infants >34 weeks' gestation born at our hospital. CONCLUSIONS: A management approach using clinical presentation to determine the need for antibiotics in chorioamnionitis-exposed infants was successful in reducing antibiotic exposure and was not associated with any clinically relevant delays in care or adverse outcomes. [ABSTRACT FROM AUTHOR]
Copyright of Pediatrics is the property of American Academy of Pediatrics and its content may not be copied or emailed to multiple sites without the copyright holder's express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)
Database: Psychology and Behavioral Sciences Collection
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  Data: Clinical Monitoring of Well-Appearing Infants Born to Mothers With Chorioamnionitis.
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  Data: <searchLink fieldCode="AR" term="%22Joshi%2C+Neha+S%2E%22">Joshi, Neha S.</searchLink><br /><searchLink fieldCode="AR" term="%22Gupta%2C+Arun%22">Gupta, Arun</searchLink><br /><searchLink fieldCode="AR" term="%22Allan%2C+Jessica+M%2E%22">Allan, Jessica M.</searchLink><br /><searchLink fieldCode="AR" term="%22Cohen%2C+Ronald+S%2E%22">Cohen, Ronald S.</searchLink><br /><searchLink fieldCode="AR" term="%22Aby%2C+Janelle+L%2E%22">Aby, Janelle L.</searchLink><br /><searchLink fieldCode="AR" term="%22Weldon%2C+Brittany%22">Weldon, Brittany</searchLink><br /><searchLink fieldCode="AR" term="%22Kim%2C+Juliann+L%2E%22">Kim, Juliann L.</searchLink><br /><searchLink fieldCode="AR" term="%22Benitz%2C+William+E%2E%22">Benitz, William E.</searchLink><br /><searchLink fieldCode="AR" term="%22Frymoyer%2C+Adam%22">Frymoyer, Adam</searchLink>
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  Data: <searchLink fieldCode="DE" term="%22Inappropriate+prescribing+%28Medicine%29%22">Inappropriate prescribing (Medicine)</searchLink><br /><searchLink fieldCode="DE" term="%22Hospitals%22">Hospitals</searchLink><br /><searchLink fieldCode="DE" term="%22Antibiotics%22">Antibiotics</searchLink><br /><searchLink fieldCode="DE" term="%22Fetal+diseases%22">Fetal diseases</searchLink><br /><searchLink fieldCode="DE" term="%22Sepsis%22">Sepsis</searchLink><br /><searchLink fieldCode="DE" term="%22Antibiotic+prophylaxis%22">Antibiotic prophylaxis</searchLink><br /><searchLink fieldCode="DE" term="%22Children%22">Children</searchLink><br /><searchLink fieldCode="DE" term="%22Pregnancy%22">Pregnancy</searchLink><br /><searchLink fieldCode="DE" term="%22Prevention%22">Prevention</searchLink><br /><searchLink fieldCode="DE" term="%22Disease+risk+factors%22">Disease risk factors</searchLink>
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  Data: BACKGROUND: The risk of early-onset sepsis is low in well-appearing late-preterm and term infants even in the setting of chorioamnionitis. The empirical antibiotic strategies for chorioamnionitis-exposed infants that are recommended by national guidelines result in antibiotic exposure for numerous well-appearing, uninfected infants. We aimed to reduce unnecessary antibiotic use in chorioamnionitis-exposed infants through the implementation of a treatment approach that focused on clinical presentation to determine the need for antibiotics. METHODS: Within a quality-improvement framework, a new treatment approach was implemented in March 2015. Well-appearing late-preterm and term infants who were exposed to chorioamnionitis were clinically monitored for at least 24 hours in a level II nursery; those who remained well appearing received no laboratory testing or antibiotics and were transferred to the level I nursery or discharged from the hospital. Newborns who became symptomatic were further evaluated and/or treated with antibiotics. Antibiotic use, laboratory testing, culture results, and clinical outcomes were collected. RESULTS: Among 277 well-appearing, chorioamnionitis-exposed infants, 32 (11.6%) received antibiotics during the first 15 months of the quality-improvement initiative. No cases of culture result-positive early-onset sepsis occurred. No infant required intubation or inotropic support. Only 48 of 277 (17%) patients had sepsis laboratory testing. The implementation of the new approach was associated with a 55% reduction (95% confidence interval 40%-65%) in antibiotic exposure across all infants >34 weeks' gestation born at our hospital. CONCLUSIONS: A management approach using clinical presentation to determine the need for antibiotics in chorioamnionitis-exposed infants was successful in reducing antibiotic exposure and was not associated with any clinically relevant delays in care or adverse outcomes. [ABSTRACT FROM AUTHOR]
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  Data: <i>Copyright of Pediatrics is the property of American Academy of Pediatrics and its content may not be copied or emailed to multiple sites without the copyright holder's express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract.</i> (Copyright applies to all Abstracts.)
PLink https://search.ebscohost.com/login.aspx?direct=true&site=eds-live&db=pbh&AN=128848082
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        Value: 10.1542/peds.2017-2056
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        Type: general
      – SubjectFull: Hospitals
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      – SubjectFull: Antibiotics
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      – SubjectFull: Fetal diseases
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      – SubjectFull: Sepsis
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      – SubjectFull: Antibiotic prophylaxis
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      – SubjectFull: United States
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              Text: Apr2018
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