Clinical dilemma of positive histologic chorioamnionitis in term newborn.
BACKGROUND
Although histologic chorioamnionitis (HCA) is known to be associated with poor outcomes in preterm infants, its clinical significance among term infants is not clearly known.


OBJECTIVE
To investigate the utility of HCA in determining early onset clinical sepsis (EOCS) among term newborns.


METHODS
The incidence of HCA and EOCS in term infants born during 2008-2009 was evaluated in a single center retrospective study (n = 3417). The predictive value of HCA for determining EOCS in term infants admitted to the neonatal intensive care unit (NICU) for suspected sepsis (n = 388) was quantified. Outcome of otherwise healthy term infants in the nursery with HCA was also investigated.


RESULTS
Overall, 11% of term infants with HCA also had EOCS. HCA was associated with increased risk for EOCS (OR 2.6, 95% confidence interval 1.6-4.2, P < 0.001) among term infants admitted to the NICU for suspected sepsis. No cases of EOCS were found among otherwise well-appearing infants in the nursery with HCA. Multiple logistic regression analysis indicated that addition of HCA does not increase the power of a model combining C-reactive protein (CRP) and immature to total neutrophil ratio in determining EOCS.


CONCLUSIONS
Although HCA in term infants is associated with EOCS, it did not improve the ability of CRP and immature to total neutrophil ratio to predict EOCS. Routine placental examination may not contribute to the diagnosis of EOCS in term infants.
Department of Pediatrics, Winthrop University Hospital , Mineola, NY , USA.
Alain
A
Cuna
Department of Pathology, Winthrop University Hospital , Mineola, NY , USA.
Laleh
L
Hakima
Department of Pathology, Winthrop University Hospital , Mineola, NY , USA.
Yun-An
YA
Tseng
Department of Pediatrics, Winthrop University Hospital , Mineola, NY , USA.
Bianca
B
Fornier
Department of Biostatistics, Winthrop University Hospital , Mineola, NY , USA.
Shahidul
S
Islam
Department of Pediatrics, Winthrop University Hospital , Mineola, NY , USA.
Maria Lyn
ML
Quintos-Alagheband
Department of Pathology, Winthrop University Hospital , Mineola, NY , USA.
Poonam
P
Khullar
Department of Pediatrics, Rutgers-Robert Wood Johnson Medical School , New Brunswick, NJ , USA.
Barry
B
Weinberger
Department of Pediatrics, Winthrop University Hospital , Mineola, NY , USA.
Nazeeh
N
Hanna
infection; newborn; placental examination