title: Revisiting the diagnostic criteria of clinical chorioamnionitis in preterm birth.
abstract: OBJECTIVE
  To re-evaluate the utility of the conventional criteria for clinical chorioamnionitis in the prediction of early-onset neonatal sepsis (EONS) in preterm birth.
  
  
  METHODS
  Retrospective cohort study.
  
  
  METHODS
  Seoul, Republic of Korea.
  
  
  METHODS
  A total of 1468 singleton births between 24 and 34 weeks due to preterm labour (n = 713) or preterm prelabour rupture of membranes (n = 755).
  
  
  METHODS
  We evaluated three diagnostic categories of clinical chorioamnionitis: Criteria 1, conventional criteria; Criteria 2, combination of any three conventional parameters without prerequisite fever; Criteria 3, Criteria 1 plus positive maternal C-reactive protein and neutrophil left-shift into minor criteria. EONS included proven or suspected sepsis within 7 days following birth. Neonatal morbidity and mortality of EONS were also reviewed.
  
  
  METHODS
  Diagnostic performance of three combinations.
  
  
  RESULTS
  The prevalence of EONS was 13.8%. Among 203 cases of EONS, maternal manifestation of clinical chorioamnionitis by criteria 1 was evident in only one out of seven, indicating 15.3% sensitivity for EONS prediction. However, with application of criteria 2, sensitivity significantly increased to 34.0%, while compromising specificity from 92.3% to 78.7%. Criteria 3 showed similar diagnostic performance compared with criteria 1 (sensitivity 16.7%, specificity 91.6%). Overall, neonatal mortality and neonatal composite morbidity in EONS were 14.9% and 67.8%, respectively, and there was no difference in neonatal morbidity and mortality between neonates whose mothers showed fever as a sign of clinical chorioamnionitis and those whose mothers did not.
  
  
  CONCLUSIONS
  The renouncement of fever as a prerequisite for the criteria of clinical chorioamnionitis could increase sensitivity for the identification of EONS, a serious outcome of preterm birth.
  
  
  CONCLUSIONS
  The renouncement of fever as an essential can increase sensitivity for prediction of neonatal sepsis.
authors.affiliation: Department of Obstetrics and Gynaecology, Samsung Medical Centre, Sungkyunkwan University School of Medicine, Seoul, Korea.
authors.forename: J-H
authors.initials: JH
authors.lastname: Sung
authors.affiliation: Department of Obstetrics and Gynaecology, Samsung Medical Centre, Sungkyunkwan University School of Medicine, Seoul, Korea.
authors.forename: S-J
authors.initials: SJ
authors.lastname: Choi
authors.affiliation: Department of Obstetrics and Gynaecology, Samsung Medical Centre, Sungkyunkwan University School of Medicine, Seoul, Korea.
authors.forename: S-Y
authors.initials: SY
authors.lastname: Oh
authors.affiliation: Department of Obstetrics and Gynaecology, Samsung Medical Centre, Sungkyunkwan University School of Medicine, Seoul, Korea.
authors.forename: C-R
authors.initials: CR
authors.lastname: Roh
authors.affiliation: Department of Obstetrics and Gynaecology, Samsung Medical Centre, Sungkyunkwan University School of Medicine, Seoul, Korea.
authors.forename: J-H
authors.initials: JH
authors.lastname: Kim
mesh_terms: D000293:Adolescent; D000328:Adult; D002821:Chorioamnionitis / Q000175:diagnosis*; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007223:Infant; D007226:Infant Mortality; D007231:Infant, Newborn; D008297:Male; D008875:Middle Aged; D000071074:Neonatal Sepsis / Q000175:diagnosis*; D007752:Obstetric Labor, Premature; D011247:Pregnancy; D047928:Premature Birth; D015995:Prevalence; D056910:Republic of Korea; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D055815:Young Adult
keywords: C-reactive protein; Clinical chorioamnionitis; fever; preterm labour; preterm prelabour rupture of membranes