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

METHODS:

  • 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

RESULTS:

  • 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%)

CONCLUSION:

  • 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’

Learn More – Primary Sources:

Incidence of fever in labor and risk of neonatal sepsis