Choriophobia: a 1-act play.
The management of a newborn born to a mother with chorioamnionitis is controversial. By using data collected on neonates born in the era of routine maternal screening for Group B Streptococcus, we calculate that the risk of early-onset sepsis in a hypothetical infant born at term to a mother with chorioamnionitis, who has a normal physical examination at birth, is likely substantially <1% if the mother's screen for Group B Streptococcus was negative. This low rate of sepsis calls into question current guidelines recommending treatment of all such newborns with intravenous antibiotics for 48 hours pending the results of a blood culture. Current guidelines for the management of infants born to mothers with chorioamnionitis also raise an important ethical issue; the recommendation to treat these infants with intravenous antibiotics is, in essence, a de facto determination of what constitutes unacceptable risk to the newborn. We argue that this determination is ultimately value-based and therefore requires broader deliberation than that which frequently occurs among medical experts who develop medical guidelines.
Department of Pediatrics, University of Washington, Box 354920, Seattle, WA 98195-4920, USA. uncjat@u.washington.edu
James A
JA
Taylor
Douglas J
DJ
Opel
D000046:Academic Medical Centers; D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D002821:Chorioamnionitis / Q000175:diagnosis* / Q000188:drug therapy*; D003299:Cooperative Behavior; D004992:Ethics, Medical; D005260:Female; D019983:Guideline Adherence / Q000941:ethics; D006801:Humans; D007231:Infant, Newborn; D007262:Infusions, Intravenous / Q000941:ethics; D033183:Interdisciplinary Communication; D007396:Internship and Residency; D008505:Medical Staff, Hospital; D011247:Pregnancy; D018805:Sepsis / Q000175:diagnosis / Q000188:drug therapy; D013290:Streptococcal Infections / Q000175:diagnosis* / Q000188:drug therapy*; D013292:Streptococcus agalactiae; D019564:Unnecessary Procedures / Q000941:ethics
D000900:Anti-Bacterial Agents