Study On The Correlation Between Intrapartum Maternal Fever And Neonatal Early-onset Sepsis

Objectives:Early onset sepsis is still an important cause of neonatal morbidity and mortality.Its risk is closely related to perinatal risk factors,especially chorioamnionitis.Intrapartum fever is a necessary condition for the diagnosis of chorioamnionitis and an important reference index for risk assessment of neonatal early-onset sepsis(EOS).There is no consensus on whether prophylactic antibiotics should be used in asymptomatic neonates with high risk factors.In this study,a retrospective study was conducted to explore the factors that affect the risk of EOS in neonates born to the women with intrapartum fever,and to improve the standardized management of antibiotic prophylactic use in neonates.Methods:566 full-term neonates born to the women with intrapartum fever were selected from January 1,2018 to August 31,2019 in the Department of Neonatology,Affiliated Hospital of Obstetrics and Gynecology,Zhejiang University Medical College.Collected clinical data of the cases were as follows: gender,mode of delivery,birth weight,gestational age,WBC and CRP for the first time within 12-48 hours after birth,time of PROM,meconium stained or purulent amniotic fluid,antibiotic use,blood culture,maternal age,gravidity and parity,peak temperature during delivery,epidural anesthesia,pregnancy complications,WBC and CRP before delivery,pathological results of placenta and GBS colonization.All the subjects were grouped and compared according to mother's peak temperature during delivery and whether or not diagnosed as EOS.In addition,we used multi factor Logistic regression analysis to assess the risk factors of EOS,drew the ROC curve,calculated the area under the curve and determined the critical value.Results:In the 566 neonates born to the women with intrapartum fever,there were 216(38.2%)newborns diagnosed as EOS including 179(31.6%)cases of clinical sepsis and 37(6.5%)cases of confirmed sepsis.The incidence of neonatal EOS in the group of high maternal hyperthermia(63.3%)was significantly higher than that in the moderate group(37.2%)and the mild group(35.5%)(P < 0.05);the ratio of PROM ? 18h?meconium staining or odor of amniotic fluid,and the incidence of GBS colonization in the EOS group were higher than those in the non EOS group(P < 0.05),but the proportion of epidural anesthesia between two groups was not obviously different(P > 0.05).For all newborns of EOS,the peak intrapartum temperature and the rate of GBS colonization in the group of confirmed sepsis diagnosed by cord blood culture were higher than those in the group of clinical sepsis(P < 0.05).According to the result of Logistic regression analysis,the peak intrapartum temperature,PROM ? 18 h,III°amniotic fluid staining or odor and GBS colonization were significant risk factors of EOS.When the maternal temperature was 38.1 ?,it was more likely to predict the occurrence of EOS;when the temperature was 38.4 ?,it was more likely to diagnose EOS.Conclusion:1.Intrapartum fever is a common clinical symptom and an important risk factor of EOS.The higher the peak maternal temperature,the higher the risk of EOS.The combination of intrapartum fever and other high risk factors(GBS colonization?PROM ? 18 h,amniotic fluid pollution)is of great value in guiding the antibiotic prophylaxis of neonates.The level of WBC and CRP of the mother before childbirth had no significant predictive value for EOS,and had little significance in guiding application of antibiotic prophylaxis.2.In this study,the proportion of the neonates that diagnosed as EOS by cord blood culture was 6.5% and the overall incidence of EOS was as high as 38.2%,which was significantly higher than that reported abroad.It suggested that taking cord blood as blood culture sample might increase the diagnosis rate of EOS,and taking non-specific test index as the basis of clinical diagnosis might lead to over diagnosis and over treatment.3.For term neonates born to the women with intrapartum fever,GBS is the most common pathogen of EOS,followed by Escherichia coli.Therefore,it is reasonable to use penicillin(or ampicillin)+ the third-generation cephalosporin to prevent or treat those neonates.