Does Intrapartum Fever Really Predict Neonatal Sepsis?
BACKGROUND AND PURPOSE:
There is guidance from the CDC, ACOG and AAP that well-appearing newborns should undergo limited evaluation for possible sepsis if mothers have suspected chorioamnionitis
In some hospitals, newborn sepsis work-up may require NICU admission
Towers et al. (AJOG, 2017) sought to evaluate the rate of fever during labor and whether there is an association with early-onset neonatal sepsis
Prospective cohort study (2011 – 2014)
Patients with fever (≥38°C) at ≥36 weeks’ gestation were evaluated for
gestational age, parity, spontaneous or induced labor, group B streptococcus status, regional anesthesia, mode of delivery, treatment with intrapartum antibiotics, and whether a clinical diagnosis of chorioamnionitis was made by the managing physician
Cases started labor afebrile but then developed fever prior to delivery with no other infectious cause identified
Neonates were assessed for blood culture results, neonatal intensive care unit admission, length of stay, and any major newborn complications
412 patients developed a fever in 6,057 deliveries (6.8%; 95% CI 6.2–7.5%)
No cases of maternal sepsis
There was no difference in rate of newborn sepsis in fever vs. control group (p=0.3)
Febrile group: 1 newborn out of 417 developed sepsis from Escherichia coli (0.24%; 95% CI 0.01–1.3%)
Non-febrile group: 4 cases of early-onset neonatal sepsis, 2 with GBS and 2 with Escherichia coli (0.07%; 95% CI 0.02–0.18%)
The incidence of intrapartum fever is common at 6.8% and consistent with retrospective studies, although is double the rate in the CDC guideline of 3.3%
Neonatal sepsis incidence rate in the population of women with fever ≥36 weeks’ gestation is rare at 0.82/1000 live births
Need to treat (NTT): 1/417 neonates
Authors suggest that the practice of follow-up cultures and universal antibiotic treatment in well-appearing newborns in the setting of intrapartum fever may not be ‘clinically sound’
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