Newborn Management Chorioamnionitis Labor Delivery Newborn management Newborn

Newborn Management Chorioamnionitis

Labor & Delivery

Newborn management

Newborn management

Impact on the Neonate • FIRS: Fetal inflammatory response syndrome • Perinatal death • Asphyxia • Early-onset sepsis • Pneumonia • IVH • Cerebral white matter damage • Long term disability including CP • 4 fold increase in near term/term Clinics in Perinatology. Tita, Alan T. N. , MD, Ph. D; Andrews, William W. , Ph. D, MD. Published May 31, 2010. Volume 37, Issue 2. Pages 339 -354.

Current recommendations CDC AAP • 2010 Guidelines for Prevention of Perinatal GBS disease • 2012 Management of Neonates with Suspected or Proven EOS

Alternatives… • Eunice Kennedy Shriver NICHD Chorioamnionitis Workshop Executive Summary Higgins. Chorioamnionitis Workshop Executive Summary. Obstet Gynecol 2016.

Neonatal sepsis calculator kp. orgeoscalc

What is “not well-appearing”? 1. Clinical illness 2. Equivocal: abnormality can be intermittent 3. Well appearing

Diagnostic tests 1 ml

Biomarkers • Acute phase proteins • CRP, procalcitonin • Cell surface antigens • CD 64 expression increases with bacterial infection • Cytokines & chemokines • IL-6, TNFα, IL-1 • Soluble adhesion molecules • E-selectin, ICAM C- Reactive Protein

Treatment • Ampicillin 100 mg/kg/dose Q 12 h • Gentamicin 4 mg/kg/dose Q 24 h

Duration of antimicrobial therapy • NICHD Executive Summary • AAP guidelines

Consequences of current practice