title: Management of newborns born to mothers with chorioamnionitis: is it time for a kinder, gentler approach?
abstract: OBJECTIVE
  Current recommendations are that newborns of mothers with chorioamnionitis have a complete blood count, blood culture, and antibiotic therapy. We hypothesized that utilizing the early-onset sepsis (EOS) risk calculator and a clinical symptom assessment could safely reduce the number of newborns subjected to laboratory testing and antibiotics.
  
  
  METHODS
  We reviewed 698 well-appearing newborns of estimated gestational age of ≥34 weeks born to mothers with chorioamnionitis.
  
  
  RESULTS
  Sixty-five percent of newborns were managed according to the guidelines; 1 (0.14%) had culture-positive EOS. A strategy based on the use of the EOS calculator and clinical appearance of the newborn would have reduced the proportion having laboratory tests and antibiotics to 12% and would not have missed any cases of EOS.
  
  
  CONCLUSIONS
  The EOS risk in well-appearing newborns of mothers with chorioamnionitis is low. Applying a strategy based on readily obtainable measures rather than the obstetrical diagnosis of chorioamnionitis would result in a substantial reduction of newborns undergoing laboratory tests and being exposed to antibiotics. Further prospective trials evaluating the safety of this approach are warranted.
authors.affiliation: Department of Pediatrics, University of Utah, Salt Lake City, UT.
authors.forename: Julie
authors.initials: J
authors.lastname: Shakib
authors.affiliation: Department of Pediatrics, University of Utah, Salt Lake City, UT.
authors.forename: Karen
authors.initials: K
authors.lastname: Buchi
authors.affiliation: Department of Pediatrics, University of Utah, Salt Lake City, UT.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Smith
authors.affiliation: Department of Pediatrics, University of Utah, Salt Lake City, UT. Electronic address: paul.young@hsc.utah.edu.
authors.forename: Paul C
authors.initials: PC
authors.lastname: Young
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D001772:Blood Cell Count; D002821:Chorioamnionitis / Q000453:epidemiology*; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D007231:Infant, Newborn; D008828:Microbiological Techniques; D017410:Practice Guidelines as Topic; D011247:Pregnancy; D018570:Risk Assessment; D018805:Sepsis / Q000175:diagnosis / Q000453:epidemiology / Q000517:prevention & control*
chemical_list: D000900:Anti-Bacterial Agents
keywords: chorioamnionitis; early-onset sepsis; newborns