title: Maternal markers for detecting early-onset neonatal infection and chorioamnionitis in cases of premature rupture of membranes at or after 34 weeks of gestation: a two-center prospective study.
abstract: BACKGROUND
  Accurate prediction of infection, including maternal chorioamnionitis and early-onset neonatal infection, remains a critical challenge in cases of preterm rupture of membranes and may influence obstetrical management. The aim of our study was to investigate the predictive value for early-onset neonatal infection and maternal histological and clinical chorioamnionitis of maternal biological markers in routine use at or after 34 weeks of gestation in women with premature rupture of membranes.
  
  
  METHODS
  We conducted a two-center prospective study of all women admitted for premature rupture of membranes at or after 34 weeks of gestation. The association of C-reactive protein, white blood cell count, vaginal sample bacteriological results, and a prediction model at admission, for early-onset neonatal infection and maternal chorioamnionitis were analyzed by comparing areas under the receiver operating characteristic curves and specificity.
  
  
  RESULTS
  The study included 399 women. In all, 4.3% of the newborns had an early-onset neonatal infection and 5.3% of the women had clinical chorioamnionitis. Histological chorioamnionitis was detected on 10.8% of 297 placentas tested. White blood cell counts and C-reactive protein concentrations were significantly associated with early-onset neonatal infection and included in a prediction model. The area under the receiver operating characteristic curve of this model was 0.82 (95% CI [0.72, 0.92]) and of C-reactive protein, 0.80 (95% CI [0.68, 0.92]) (p = 1.0). Specificity was significantly higher for C-reactive protein than for the prediction model (48% and 43% respectively, p < 0.05). C-reactive protein was associated with clinical and histological chorioamnionitis, with areas under the receiver operating characteristic curve of 0.61 (95% CI [0.48, 0.74]) and 0.62 (95% CI [0.47, 0.74]), respectively.
  
  
  CONCLUSIONS
  The concentration of C-reactive protein at admission for premature rupture of membranes is the most accurate infectious marker for prediction of early-onset neonatal infection in routine use with a sensitivity > 90%. A useful next step would be a randomized prospective study of management strategy comparing CRP at admission with active management to assess whether this more individualized care is a safe alternative strategy in women with premature rupture of membranes at or after 34 weeks.
authors.affiliation: Epidemiological Research Unit on Perinatal and Women's Health, INSERM U953, Paris, France. thomas.popof@wanadoo.fr
authors.forename: Thomas
authors.initials: T
authors.lastname: Popowski
authors.forename: François
authors.initials: F
authors.lastname: Goffinet
authors.forename: Françoise
authors.initials: F
authors.lastname: Maillard
authors.forename: Thomas
authors.initials: T
authors.lastname: Schmitz
authors.forename: Sandrine
authors.initials: S
authors.lastname: Leroy
authors.forename: Gilles
authors.initials: G
authors.lastname: Kayem
mesh_terms: D000328:Adult; D015415:Biomarkers / Q000097:blood; D002097:C-Reactive Protein / Q000032:analysis*; D002821:Chorioamnionitis / Q000097:blood / Q000175:diagnosis* / Q000188:drug therapy; D005260:Female; D005322:Premature Rupture of Fetal Membranes; D005865:Gestational Age; D006801:Humans; D007231:Infant, Newborn; D007958:Leukocyte Count; D008954:Models, Biological; D011247:Pregnancy; D011446:Prospective Studies; D012372:ROC Curve; D012680:Sensitivity and Specificity; D018805:Sepsis / Q000097:blood / Q000134:cerebrospinal fluid / Q000175:diagnosis*; D014621:Vagina / Q000382:microbiology
chemical_list: D015415:Biomarkers; D002097:C-Reactive Protein