title: Chorioamnionitis and Culture-Confirmed, Early-Onset Neonatal Infections.
abstract: BACKGROUND
  Current guidelines for prevention of neonatal group B streptococcal disease recommend diagnostic evaluations and empirical antibiotic therapy for well-appearing, chorioamnionitis-exposed newborns. Some clinicians question these recommendations, citing the decline in early-onset group B streptococcal disease rates since widespread intrapartum antibiotic prophylaxis implementation and potential antibiotic risks. We aimed to determine whether chorioamnionitis-exposed newborns with culture-confirmed, early-onset infections can be asymptomatic at birth.
  
  
  METHODS
  Multicenter, prospective surveillance for early-onset neonatal infections was conducted during 2006-2009. Early-onset infection was defined as isolation of a pathogen from blood or cerebrospinal fluid collected ≤ 72 hours after birth. Maternal chorioamnionitis was defined by clinical diagnosis in the medical record or by histologic diagnosis by placental pathology. Hospital records of newborns with early-onset infections born to mothers with chorioamnionitis were reviewed retrospectively to determine symptom onset.
  
  
  RESULTS
  Early-onset infections were diagnosed in 389 of 396,586 live births, including 232 (60%) chorioamnionitis-exposed newborns. Records for 229 were reviewed; 29 (13%) had no documented symptoms within 6 hours of birth, including 21 (9%) who remained asymptomatic at 72 hours. Intrapartum antibiotic prophylaxis exposure did not differ significantly between asymptomatic and symptomatic infants (76% vs 69%; P = .52). Assuming complete guideline implementation, we estimated that 60 to 1400 newborns would receive diagnostic evaluations and antibiotics for each infected asymptomatic newborn, depending on chorioamnionitis prevalence.
  
  
  CONCLUSIONS
  Some infants born to mothers with chorioamnionitis may have no signs of sepsis at birth despite having culture-confirmed infections. Implementation of current clinical guidelines may result in early diagnosis, but large numbers of uninfected asymptomatic infants would be treated.
authors.affiliation: Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia vij5@cdc.gov.
authors.forename: Jonathan M
authors.initials: JM
authors.lastname: Wortham
authors.affiliation: Social, Statistical, and Environmental Sciences, RTI International, Research Triangle Park, North Carolina;
authors.forename: Nellie I
authors.initials: NI
authors.lastname: Hansen
authors.affiliation: National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia;
authors.forename: Stephanie J
authors.initials: SJ
authors.lastname: Schrag
authors.affiliation: Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia; Children's Healthcare of Atlanta, Atlanta, Georgia;
authors.forename: Ellen
authors.initials: E
authors.lastname: Hale
authors.affiliation: Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine and Lucile Packard Children's Hospital, Palo Alto, California;
authors.forename: Krisa
authors.initials: K
authors.lastname: Van Meurs
authors.affiliation: Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, Texas;
authors.forename: Pablo J
authors.initials: PJ
authors.lastname: Sánchez
authors.affiliation: Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, Texas;
authors.forename: Joseph B
authors.initials: JB
authors.lastname: Cantey
authors.affiliation: Division of Neonatology, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, Utah;
authors.forename: Roger
authors.initials: R
authors.lastname: Faix
authors.affiliation: Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana;
authors.forename: Brenda
authors.initials: B
authors.lastname: Poindexter
authors.affiliation: Department of Pediatrics, Duke University, Durham, North Carolina;
authors.forename: Ronald
authors.initials: R
authors.lastname: Goldberg
authors.affiliation: Department of Pediatrics, Yale University School of Medicine, New Haven, Connecticut;
authors.forename: Matthew
authors.initials: M
authors.lastname: Bizzarro
authors.affiliation: Department of Pediatrics, Floating Hospital for Children, Tufts Medical Center, Boston, Massachusetts; and.
authors.forename: Ivan
authors.initials: I
authors.lastname: Frantz
authors.affiliation: Social, Statistical, and Environmental Sciences, RTI International, Rockville, Maryland.
authors.forename: Abhik
authors.initials: A
authors.lastname: Das
authors.affiliation: Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine and Lucile Packard Children's Hospital, Palo Alto, California;
authors.forename: William E
authors.initials: WE
authors.lastname: Benitz
authors.affiliation: Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia; Children's Healthcare of Atlanta, Atlanta, Georgia;
authors.forename: Andi L
authors.initials: AL
authors.lastname: Shane
authors.affiliation: Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland.
authors.forename: Rosemary
authors.initials: R
authors.lastname: Higgins
authors.affiliation: Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia; Children's Healthcare of Atlanta, Atlanta, Georgia;
authors.forename: Barbara J
authors.initials: BJ
authors.lastname: Stoll
mesh_terms: D058345:Asymptomatic Infections; D001424:Bacterial Infections / Q000175:diagnosis* / Q000382:microbiology*; D001431:Bacteriological Techniques; D002821:Chorioamnionitis / Q000382:microbiology*; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D011247:Pregnancy; D011446:Prospective Studies; D012189:Retrospective Studies