Close
New

Medscape is available in 5 Language Editions – Choose your Edition here.

 

Chorioamnionitis Treatment & Management

  • Author: Michael P Sherman, MD, FAAP; Chief Editor: Ted Rosenkrantz, MD  more...
 
Updated: Jan 02, 2016
 

Medical Care

This section addresses 2 topics. The first topic includes maternal interventions to treat suspected chorioamnionitis and protect the fetus from infection. The second topic includes the diagnostic approach and the appropriate treatment of neonates born to mothers with suspected chorioamnionitis.

The observation that epidural anesthesia during labor may create findings suggestive of maternal chorioamnionitis is discussed. A maternal fever that occurs when epidural anesthesia is administered during the intrapartum period has often been interpreted as chorioamnionitis. This may not be the case, and the neonate is needlessly treated after birth.

Using ampicillin as the chemoprophylactic agent to prevent group B streptococcal (GBS) disease in the neonate is associated with other issues. Ampicillin-resistant E coli infections in the mother and her infant are reported as an increasing problem. The use of penicillin rather than ampicillin as the chemotherapeutic agent to prevent GBS infections of the newborn is encouraged.[176] The effectiveness of erythromycin, clindamycin, and vancomycin for prevention of neonatal GBS disease requires additional study. These antibiotics are often applied when a mother gives a history of penicillin allergy. Frequently, the maternal history of penicillin allergy is poorly documented.

Obstetric management influencing neonatal outcome

When acute chorioamnionitis is evident, delivery must be expedited. Upon signs of serious fetal distress, delivery must be emergent. Withholding maternal antibiotics to obtain postnatal cultures from the neonate is no longer appropriate. This strategy was once an accepted practice based on the assumption that waiting to obtain cultures from the newborn helps to determine the cause of infection. The morbidity and mortality in the mother and newborn may actually increase because of a delay in administering antibiotics. Studies suggest that obtaining cultures from the mother and beginning antibiotics before delivery probably improves the outcome for the neonate.[1]

The postnatal physician must decide whether the fetus was infected and whether antibiotics given before birth should be continued in the neonate. Those antibiotics may differ from those administered to the mother. The history, physical findings, and findings of certain laboratory studies can assist the physician in deciding whether to continue antibiotics started during the intrapartum period. Because antibiotic chemoprophylaxis reduces the risk of GBS infection in neonates, the physician must always consider beginning penicillin during the intrapartum period when a mother has defined risk factors for GBS disease.[176, 177] The physician for the infant must judge whether the chemoprophylaxis was sufficient to prevent infection (especially in a healthy, full-term neonate) or whether the infant must continue antibiotic therapy after birth.

The US Centers for Disease Control and Prevention (CDC) guidelines outline the strategies for screening and treatment to prevent neonatal disease caused byGBS.[146, 178] New CDC guidelines for the prevention and treatment of neonatal GBS disease were published in 2010.

Determining the appropriate procedures to prevent fetal infection in the setting of premature, prelabor, rupture of membranes is more complex. The mother who has preterm labor or premature rupture of membranes at less than 34 weeks' gestation and no clinical signs or symptoms of chorioamnionitis should receive corticosteroid therapy.[50]

Attitudes towards antibiotic use have changed. If GBS colonization of the mother is not present, and signs and symptoms of chorioamnionitis are absent, pregnant women with preterm labor or premature rupture of membranes at more than 36 weeks' gestation should be observed for infection. Thus, prophylactic antibiotics are not given in these circumstances. Mothers at term gestation with accepted risk factors for GBS infection in their fetus should also receive chemoprophylaxis. Infants at risk of preterm birth, and in whom GBS status is unknown, receive antibiotics during latency until GBS screening is completed. A period of observation for maternal and/or fetal infection is also required after admission, although signs and symptoms may not be evident (ie, silent disease).

Planned early birth versus expectant management for women with premature, prelabor rupture of membranes prior to 37 weeks' gestation and planned home versus hospital care for women with premature, prelabor rupture of membranes prior to 37 weeks' gestation have been reviewed.[179, 180] The preexisting studies were judged inadequate for clinical decision-making on these two topics.

Some obstetricians have observed little effect of corticosteroids on lung maturity after 32 weeks' gestation, whereas others have extended the use of corticosteroids to 34 weeks' gestation. Studies have not clearly demonstrated that the use of corticosteroids increases the risk of bacterial infection in the fetus.[50]

The use of intrapartum penicillin or ampicillin is now a recognized therapy to prevent fetal infection or early onset neonatal infections associated with urogenital colonization by GBS.[181] Amstey and Gibbs recommended that penicillin G rather than ampicillin be administered to the mother for the prevention of early-onset neonatal GBS disease.[176, 182] Their rationale was that penicillin G chemoprophylaxis does not increase colonization of the urogenital tract with ampicillin-resistant gram-negative bacteria. This assumption now seems correct, based on a report showing intrapartum ampicillin did not increase neonatal infections caused by ampicillin-resistant E coli.[17]

Conversely, reports showed an increased occurrence of infections caused by ampicillin-resistant E coli in premature neonates.[183, 184] These mothers had received ampicillin for chemoprophylaxis rather than penicillin, and these authors again recommended use of intrapartum penicillin to prevent fetal or early onset neonatal infections caused by GBS.

Neonatal immunology and the risks created by maternal chorioamnionitis

Newborns are vulnerable to infection because of an immature immune system.[185] Factors that render neonates susceptible to bacterial infections include reduced numbers and/or function of macrophages and dendritic cells in peripheral tissues (eg, lung); lower numbers of neutrophils in the bone marrow storage pool[163] ; decreased immunoglobulin G (IgG) and complement levels, especially in prematurely born infants; an inability to respond to bacterial carbohydrate antigens; an increased percentage of T cells bearing naïve cell surfaces and correspondingly underdeveloped functional behaviors related to foreign antigens; and anatomic and biochemical immaturity of skin and mucosal barriers (eg, lung and gut epithelia) as they relate to local host defenses.

Emerging treatments, such as the use of intravenous immunoglobulins and hematopoietic growth factors, may correct deficiencies of the neonatal immune system.[186] The use of immunotherapy still requires more investigation before these treatments become a standard of care.[187] Specifically, the routine use of intravenous immunoglobins to treat neonatal sepsis is not established, but may be evident in the near future.[188] The mainstays of current neonatal intensive care for bacterial sepsis in neonates are prompt recognition of bacterial infection, antimicrobial therapy, and supportive care. In this review, supportive care is only briefly discussed below. See the Medscape Reference article Neonatal Sepsis for a more in-depth care of these critically-ill neonates.

Treatment of the neonate

Communication between obstetric and pediatric caregivers is essential to recognize neonatal infection.

Recognition or suspicion of maternal chorioamnionitis is essential to reducing neonatal morbidity and mortality caused by early-onset bacterial infections in the neonate. Nurses and physicians who care for the mother must communicate their concerns about maternal infection to the nurses and physicians who care for the newborn after birth. Caregivers in the nursery must be critically aware of a neonate's signs and symptoms in relationship to the antepartum and intrapartum history.

Signs and symptoms in the mother that suggest chorioamnionitis and increase the risk of fetal or neonatal infection are described in Physical. Although numerous ways to approach the diagnosis and treatment of neonatal sepsis are recognized, a hands-on assessment is the main key to recognition. The experienced physician or nurse in the nursery may indicate to fellow caregivers that the newborn has a septic appearance.

Next

Surgical Care

Surgical interventions are infrequently required in early onset bacterial infections of the neonate. The conditions that may require intervention include epidural or brain abscess, subcutaneous abscesses, infections localized to the pleural space, certain intra-abdominal infections (especially if intestinal perforation is present), and bone or joint infections.

Previous
Next

Consultations

Depending on the hospital setting and the status of the neonate, a family physician may seek pediatric consultation. Depending on the severity or nature of infection in a hospital setting, the pediatrician may seek consultation with a neonatologist, a pediatric infectious disease subspecialist, or both. If organ system failure is present or impending organ system failure (eg, respiratory, cardiovascular, renal) secondary to infection is a concern, the infant should be transferred to an appropriate level 3 or level 4 neonatal intensive care unit (NICU). Transportation to a level 3 or 4 NICU is clearly indicated for extremely premature infants requiring high-frequency oscillatory ventilation or near-term or term neonates (≥ 35 weeks' gestation) who are close to meeting criteria for extracorporeal membrane oxygenation (ECMO).

Previous
Next

Diet

Seriously or critically-ill newborns with early-onset bacterial infections often require parenteral nutrition until the condition improves. The use of intravenous lipids during proven bacteremia is the subject of controversy. The fear is that lipid inclusions may interfere with phagocytosis of microbes by hepatic, splenic, or pulmonary macrophages. Infections involving the GI tract may need a special approach to enteral nutrition when the feedings are reinstituted.

Previous
Next

Activity

Activity and illness is generally related to adults because neonates are typically at rest and are not stressed when seriously or critically ill.

Previous
 
 
Contributor Information and Disclosures
Author

Michael P Sherman, MD, FAAP Professor, Department of Child Health, University of Missouri-Columbia School of Medicine; Neonatologist, Women’s and Children’s Hospital; Professor Emeritus, Department of Pediatrics, University of California, Davis, School of Medicine

Michael P Sherman, MD, FAAP is a member of the following medical societies: American Pediatric Society, American Society for Microbiology, American Thoracic Society, Pediatric Infectious Diseases Society, American Association for the Advancement of Science, European Society for Paediatric Research, Western Society for Pediatric Research, Perinatal Research Society, American Academy of Pediatrics, American Association of Immunologists, Society for Pediatric Research

Disclosure: Nothing to disclose.

Coauthor(s)

Katsufumi Otsuki, MD, PhD Associate Professor, Chief, Department of Obstetrics and Gynecology, Showa University Koto-Toyosu Hospital, Japan

Disclosure: Nothing to disclose.

Naomi F Lauriello, MD Assistant Professor of Neonatology, University of Missouri Women’s and Children’s Hospital

Naomi F Lauriello, MD is a member of the following medical societies: American Academy of Pediatrics

Disclosure: Partner received consulting fee from Janssen Scientific Affairs for consulting; Partner received consulting fee from Reckitt Benckisser Pharmaceuticals for consulting.

Specialty Editor Board

Mary L Windle, PharmD Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

Arun K Pramanik, MD, MBBS Professor of Pediatrics, Louisiana State University Health Sciences Center

Arun K Pramanik, MD, MBBS is a member of the following medical societies: American Academy of Pediatrics, American Thoracic Society, National Perinatal Association, Southern Society for Pediatric Research

Disclosure: Nothing to disclose.

Chief Editor

Ted Rosenkrantz, MD Professor, Departments of Pediatrics and Obstetrics/Gynecology, Division of Neonatal-Perinatal Medicine, University of Connecticut School of Medicine

Ted Rosenkrantz, MD is a member of the following medical societies: American Academy of Pediatrics, American Pediatric Society, Eastern Society for Pediatric Research, American Medical Association, Connecticut State Medical Society, Society for Pediatric Research

Disclosure: Nothing to disclose.

Additional Contributors

Ted Rosenkrantz, MD Professor, Departments of Pediatrics and Obstetrics/Gynecology, Division of Neonatal-Perinatal Medicine, University of Connecticut School of Medicine

Ted Rosenkrantz, MD is a member of the following medical societies: American Academy of Pediatrics, American Pediatric Society, Eastern Society for Pediatric Research, American Medical Association, Connecticut State Medical Society, Society for Pediatric Research

Disclosure: Nothing to disclose.

Acknowledgements

Research by the author, Michael Sherman, is supported by NIH grant R44 HD 057744 and a grant from the Gerber Foundation. The author appreciates the review of the manuscript undertaken by Jan Sherman, RN, NNP, PhD, and her helpful recommendations for improvement.

References
  1. Snyder M, Crawford P, Jamieson B, Neher JO. Clinical inquiries. What treatment approach to intrapartum maternal fever has the best fetal outcomes?. J Fam Pract. 2007 May. 56(5):401-2. [Medline].

  2. Driscoll SG. Chorioamnionitis: perinatal morbidity and mortality. Pediatr Infect Dis. 1986 Nov-Dec. 5(6 Suppl):S273-5. [Medline].

  3. Apantaku O, Mulik V. Maternal intra-partum fever. J Obstet Gynaecol. 2007 Jan. 27(1):12-5. [Medline].

  4. Buhimschi CS, Bhandari V, Hamar BD, et al. Proteomic profiling of the amniotic fluid to detect inflammation, infection, and neonatal sepsis. PLoS Med. 2007 Jan. 4(1):e18. [Medline].

  5. Joram N, Boscher C, Denizot S. Umbilical cord blood procalcitonin and C reactive protein concentrations as markers for early diagnosis of very early onset neonatal infection. Arch Dis Child Fetal Neonatal Ed. 2006 Jan. 91(1):F65-6. [Medline].

  6. Hassan S, Romero R, Hendler I, et al. A sonographic short cervix as the only clinical manifestation of intra-amniotic infection. J Perinat Med. 2006. 34(1):13-9. [Medline].

  7. Kusanovic JP, Espinoza J, Romero R, et al. Clinical significance of the presence of amniotic fluid 'sludge' in asymptomatic patients at high risk for spontaneous preterm delivery. Ultrasound Obstet Gynecol. 2007 Oct. 30(5):706-14. [Medline].

  8. Rizzo G, Capponi A, Vlachopoulou A, Angelini E, Grassi C, Romanini C. Ultrasonographic assessment of the uterine cervix and interleukin-8 concentrations in cervical secretions predict intrauterine infection in patients with preterm labor and intact membranes. Ultrasound Obstet Gynecol. 1998 Aug. 12(2):86-92. [Medline].

  9. Reilly SD, Faye-Petersen OM. Chorioamnionitis and Funisitis: Their Implications for the Neonate. NeoReviews. September 2008. 9:e411-e417. [Full Text].

  10. Escobar GJ. The neonatal "sepsis work-up": personal reflections on the development of an evidence-based approach toward newborn infections in a managed care organization. Pediatrics. 1999 Jan. 103(1 Suppl E):360-73. [Medline].

  11. Callaghan WM, MacDorman MF, Rasmussen SA, Qin C, Lackritz EM. The contribution of preterm birth to infant mortality rates in the United States. Pediatrics. 2006 Oct. 118(4):1566-73. [Medline].

  12. Dutta S, Reddy R, Sheikh S, Kalra J, Ray P, Narang A. Intrapartum antibiotics and risk factors for early onset sepsis. Arch Dis Child Fetal Neonatal Ed. 2010 Mar. 95(2):F99-103. [Medline].

  13. Larsen JW, Sever JL. Group B Streptococcus and pregnancy: a review. Am J Obstet Gynecol. 2008 Apr. 198(4):440-8; discussion 448-50. [Medline].

  14. Baltimore RS. Consequences of prophylaxis for group B streptococcal infections of the neonate. Semin Perinatol. 2007 Feb. 31(1):33-8. [Medline].

  15. Stoll BJ, Hansen NI, Higgins RD. Very low birth weight preterm infants with early onset neonatal sepsis: the predominance of gram-negative infections continues in the National Institute of Child Health and Human Development Neonatal Research Network, 2002-2003. Pediatr Infect Dis J. 2005 Jul. 24(7):635-9. [Medline].

  16. Bizzarro MJ, Dembry LM, Baltimore RS, Gallagher PG. Changing patterns in neonatal Escherichia coli sepsis and ampicillin resistance in the era of intrapartum antibiotic prophylaxis. Pediatrics. 2008 Apr. 121(4):689-96. [Medline].

  17. Schrag SJ, Hadler JL, Arnold KE, Martell-Cleary P, Reingold A, Schuchat A. Risk factors for invasive, early-onset Escherichia coli infections in the era of widespread intrapartum antibiotic use. Pediatrics. 2006 Aug. 118(2):570-6. [Medline].

  18. Bratu S, Eramo A, Kopec R. Community-associated methicillin-resistant Staphylococcus aureus in hospital nursery and maternity units. Emerg Infect Dis. 2005 Jun. 11(6):808-13. [Medline].

  19. Andrews WW, Schelonka R, Waites K, Stamm A, Cliver SP, Moser S. Genital tract methicillin-resistant Staphylococcus aureus: risk of vertical transmission in pregnant women. Obstet Gynecol. 2008 Jan. 111(1):113-8. [Medline].

  20. Hollier L, Wendel GD, ed. Infectious diseases in pregnancy. Clin Perinatol. 2005. 32(3):523-824. [Full Text].

  21. Romero R, Espinoza J, Goncalves LF, Kusanovic JP, Friel L, Hassan S. The role of inflammation and infection in preterm birth. Semin Reprod Med. 2007 Jan. 25(1):21-39. [Medline].

  22. Romero R, Gotsch F, Pineles B, Kusanovic JP. Inflammation in pregnancy: its roles in reproductive physiology, obstetrical complications, and fetal injury. Nutr Rev. 2007 Dec. 65(12 Pt 2):S194-202. [Medline].

  23. Malaeb S, Dammann O. Fetal inflammatory response and brain injury in the preterm newborn. J Child Neurol. 2009 Sep. 24(9):1119-26. [Medline].

  24. Hitti J, Hillier SL, Agnew KJ, Krohn MA, Reisner DP, Eschenbach DA. Vaginal indicators of amniotic fluid infection in preterm labor. Obstet Gynecol. 2001 Feb. 97(2):211-9. [Medline].

  25. Al-Adnani M, Sebire NJ. The role of perinatal pathological examination in subclinical infection in obstetrics. Best Pract Res Clin Obstet Gynaecol. 2007 Jun. 21(3):505-21. [Medline].

  26. Anderson BL, Simhan HN, Simons KM, Wiesenfeld HC. Untreated asymptomatic group B streptococcal bacteriuria early in pregnancy and chorioamnionitis at delivery. Am J Obstet Gynecol. 2007 Jun. 196(6):524.e1-5. [Medline].

  27. Hakansson S, Kallen K. High maternal body mass index increases the risk of neonatal early onset group B streptococcal disease. Acta Paediatr. 2008 Oct. 97(10):1386-9. [Medline].

  28. Swadpanich U, Lumbiganon P, Prasertcharoensook W, Laopaiboon M. Antenatal lower genital tract infection screening and treatment programs for preventing preterm delivery. Cochrane Database Syst Rev. 2008 Apr 16. CD006178. [Medline].

  29. McDonald HM, Brocklehurst P, Gordon A. Antibiotics for treating bacterial vaginosis in pregnancy. Cochrane Database Syst Rev. 2007 Jan 24. CD000262. [Medline].

  30. Siqueira FM, Cota LO, Costa JE, Haddad JP, Lana AM, Costa FO. Intrauterine growth restriction, low birth weight, and preterm birth: adverse pregnancy outcomes and their association with maternal periodontitis. J Periodontol. 2007 Dec. 78(12):2266-76. [Medline].

  31. Aly H, Alhabashi G, Hammad TA, Owusu-Ansah S, Bathgate S, Mohamed M. ABO phenotype and other risk factors associated with chorioamnionitis. J Pediatr. 2008 Jul. 153(1):16-8. [Medline].

  32. Kabiru W, Raynor BD. Obstetric outcomes associated with increase in BMI category during pregnancy. Am J Obstet Gynecol. 2004 Sep. 191(3):928-32. [Medline].

  33. Raatikainen K, Heiskanen N, Heinonen S. Transition from overweight to obesity worsens pregnancy outcome in a BMI-dependent manner. Obesity (Silver Spring). 2006 Jan. 14(1):165-71. [Medline].

  34. Joy SD, Zhao Y, Mercer BM, et al. Latency and infectious complications after preterm premature rupture of membranes: impact of body mass index. Am J Obstet Gynecol. 2009 Dec. 201(6):600.e1-5. [Medline].

  35. Lee SE, Romero R, Park CW, Jun JK, Yoon BH. The frequency and significance of intraamniotic inflammation in patients with cervical insufficiency. Am J Obstet Gynecol. 2008 Jun. 198(6):633.e1-8. [Medline].

  36. Heinemann J, Gillen G, Sanchez-Ramos L, Kaunitz AM. Do mechanical methods of cervical ripening increase infectious morbidity? A systematic review. Am J Obstet Gynecol. 2008 Aug. 199(2):177-87; discussion 187-8. [Medline].

  37. Alfirevic Z, Kelly AJ, Dowswell T. Intravenous oxytocin alone for cervical ripening and induction of labour. Cochrane Database Syst Rev. 2009 Oct 7. CD003246. [Medline].

  38. King AE, Kelly RW, Sallenave JM, Bocking AD, Challis JR. Innate immune defences in the human uterus during pregnancy. Placenta. 2007 Nov-Dec. 28(11-12):1099-106. [Medline].

  39. Verma RP, Kaplan C, Southerton K, Niwas R, Verma R, Fang H. Placental histopathology in the extremely low birth weight infants. Fetal Pediatr Pathol. 2008 Aug. 27(2):53-61. [Medline].

  40. Newton ER. Preterm labor, preterm premature rupture of membranes, and chorioamnionitis. Clin Perinatol. 2005 Sep. 32(3):571-600. [Medline].

  41. Mecredy RL, Wiswell TE, Hume RF. Outcome of term gestation neonates whose mothers received intrapartum antibiotics for suspected chorioamnionitis. Am J Perinatol. 1993 Sep. 10(5):365-8. [Medline].

  42. Karpuch J, Goldberg M, Kohelet D. Neonatal bacteremia. A 4-year prospective study. Isr J Med Sci. 1983 Nov. 19(11):963-6. [Medline].

  43. Gilstrap LC 3rd, Leveno KJ, Cox SM, Burris JS, Mashburn M, Rosenfeld CR. Intrapartum treatment of acute chorioamnionitis: impact on neonatal sepsis. Am J Obstet Gynecol. 1988 Sep. 159(3):579-83. [Medline].

  44. Obi SN, Ozumba BC. Pre-term premature rupture of fetal membranes: the dilemma of management in a developing nation. J Obstet Gynaecol. 2007 Jan. 27(1):37-40. [Medline].

  45. Naeye RL, Tafari N, Judge D, Gilmour D, Marboe C. Amniotic fluid infections in an African city. J Pediatr. 1977 Jun. 90(6):965-70. [Medline].

  46. Appelbaum PC, Ross SM, Dhupelia I, Naeye RL. The effect of diet supplementation and addition of zinc in vitro on the growth-supporting property of amniotic fluid in African women. Am J Obstet Gynecol. 1979 Sep 1. 135(1):82-4. [Medline].

  47. Katona P, Katona-Apte J. The interaction between nutrition and infection. Clin Infect Dis. 2008 May 15. 46(10):1582-8. [Medline].

  48. Chacko B, Sohi I. Early onset neonatal sepsis. Indian J Pediatr. 2005 Jan. 72(1):23-6. [Medline].

  49. Sundaram V, Kumar P, Dutta S, et al. Blood culture confirmed bacterial sepsis in neonates in a North Indian tertiary care center: changes over the last decade. Jpn J Infect Dis. 2009 Jan. 62(1):46-50. [Medline].

  50. Goldenberg RL, Andrews WW, Faye-Petersen OM, Cliver SP, Goepfert AR, Hauth JC. The Alabama preterm birth study: corticosteroids and neonatal outcomes in 23- to 32-week newborns with various markers of intrauterine infection. Am J Obstet Gynecol. 2006 Oct. 195(4):1020-4. [Medline].

  51. Soraisham AS, Singhal N, McMillan DD, Sauve RS, Lee SK. A multicenter study on the clinical outcome of chorioamnionitis in preterm infants. Am J Obstet Gynecol. 2009 Apr. 200(4):372.e1-6. [Medline].

  52. Gaudet LM, Flavin M, Islam O, Smith GN. Diffusion MRI brain findings in neonates exposed to chorioamnionitis: a case series. J Obstet Gynaecol Can. 2009 Jun. 31(6):497-503. [Medline].

  53. Neufeld MD, Frigon C, Graham AS, Mueller BA. Maternal infection and risk of cerebral palsy in term and preterm infants. J Perinatol. 2005 Feb. 25(2):108-13. [Medline].

  54. Versland LB, Sommerfelt K, Elgen I. Maternal signs of chorioamnionitis: persistent cognitive impairment in low-birthweight children. Acta Paediatr. 2006 Feb. 95(2):231-5. [Medline].

  55. Wu YW, Croen LA, Torres AR, Van De Water J, Grether JK, Hsu NN. Interleukin-6 genotype and risk for cerebral palsy in term and near-term infants. Ann Neurol. 2009 Nov. 66(5):663-70. [Medline].

  56. Bashiri A, Burstein E, Mazor M. Cerebral palsy and fetal inflammatory response syndrome: a review. J Perinat Med. 2006. 34(1):5-12. [Medline].

  57. Hagberg H, Mallard C, Jacobsson B. Role of cytokines in preterm labour and brain injury. BJOG. 2005 Mar. 112 Suppl 1:16-8. [Medline].

  58. Ito M, Nakashima A, Hidaka T, et al. A role for IL-17 in induction of an inflammation at the fetomaternal interface in preterm labour. J Reprod Immunol. 2010 Jan. 84(1):75-85. [Medline].

  59. Redline R, Minich N, Taylor H, Hack M. Placental lesions as predictors of cerebral palsy and abnormal neurocognitive function at school age in extremely low birth weight infants (11Pediatr Dev Pathol</i>. 2007 Mar 22. 1. [Medline].

  60. Viscardi RM, Muhumuza CK, Rodriguez A, et al. Inflammatory markers in intrauterine and fetal blood and cerebrospinal fluid compartments are associated with adverse pulmonary and neurologic outcomes in preterm infants. Pediatr Res. 2004 Jun. 55(6):1009-17. [Medline].

  61. Schelonka RL, Waites KB. Ureaplasma infection and neonatal lung disease. Semin Perinatol. 2007 Feb. 31(1):2-9. [Medline].

  62. Kasper DC, Mechtler TP, Reischer GH, et al. The bacterial load of Ureaplasma parvum in amniotic fluid is correlated with an increased intrauterine inflammatory response. Diagn Microbiol Infect Dis. 2010 Mar 4. [Medline].

  63. Namba F, Hasegawa T, Nakayama M, et al. Placental features of chorioamnionitis colonized with Ureaplasma species in preterm delivery. Pediatr Res. 2010 Feb. 67(2):166-72. [Medline].

  64. Jenkins DD, Wiest DB, Mulvihill DM, et al. Fetal and neonatal effects of N-acetylcysteine when used for neuroprotection in maternal chorioamnionitis. J Pediatr. 2016 Jan. 168:67-76.e6. [Medline].

  65. Adams-Chapman I, Stoll BJ. Neonatal infection and long-term neurodevelopmental outcome in the preterm infant. Curr Opin Infect Dis. 2006 Jun. 19(3):290-7. [Medline].

  66. Ragouilliaux CJ, Keeney SE, Hawkins HK, Rowen JL. Maternal factors in extremely low birth weight infants who develop spontaneous intestinal perforation. Pediatrics. 2007 Dec. 120(6):e1458-64. [Medline].

  67. Wu YW, Escobar GJ, Grether JK, Croen LA, Greene JD, Newman TB. Chorioamnionitis and cerebral palsy in term and near-term infants. JAMA. 2003 Nov 26. 290(20):2677-84. [Medline].

  68. Dulay AT, Buhimschi IA, Zhao G, et al. Nucleated red blood cells are a direct response to mediators of inflammation in newborns with early-onset neonatal sepsis. Am J Obstet Gynecol. 2008 Apr. 198(4):426.e1-9. [Medline].

  69. Redline RW. Elevated circulating fetal nucleated red blood cells and placental pathology in term infants who develop cerebral palsy. Hum Pathol. 2008 Sep. 39(9):1378-84. [Medline].

  70. Buhimschi CS, Bhandari V, Han YW, et al. Using proteomics in perinatal and neonatal sepsis: hopes and challenges for the future. Curr Opin Infect Dis. 2009 Jun. 22(3):235-43. [Medline].

  71. Digiulio DB, Romero R, Kusanovic JP, et al. Prevalence and Diversity of Microbes in the Amniotic Fluid, the Fetal Inflammatory Response, and Pregnancy Outcome in Women with Preterm Pre-Labor Rupture of Membranes. Am J Reprod Immunol. 2010 Mar 21. [Medline].

  72. Romero R, Kusanovic JP, Gotsch F, Erez O, Vaisbuch E, Mazaki-Tovi S. Isobaric labeling and tandem mass spectrometry: a novel approach for profiling and quantifying proteins differentially expressed in amniotic fluid in preterm labor with and without intra-amniotic infection/inflammation. J Matern Fetal Neonatal Med. 2010 Apr. 23(4):261-80. [Medline].

  73. Holzman C, Lin X, Senagore P, Chung H. Histologic chorioamnionitis and preterm delivery. Am J Epidemiol. 2007 Oct 1. 166(7):786-94. [Medline].

  74. Berenson AB, Wiemann CM, Wilkinson GS. Perinatal morbidity associated with violence experienced by pregnant women. Am J Obstet Gynecol. 1994 Jun. 170(6):1760-6; discussion 1766-9. [Medline].

  75. Turner BJ, McKee LJ, Silverman NS. Prenatal care and birth outcomes of a cohort of HIV-infected women. J Acquir Immune Defic Syndr Hum Retrovirol. 1996 Jul. 12(3):259-67. [Medline].

  76. Scholl TO. High third-trimester ferritin concentration: associations with very preterm delivery, infection, and maternal nutritional status. Obstet Gynecol. 1998 Aug. 92(2):161-6. [Medline].

  77. Romero R, Chaiworapongsa T, Espinoza J. Micronutrients and intrauterine infection, preterm birth and the fetal inflammatory response syndrome. J Nutr. 2003 May. 133(5 Suppl 2):1668S-1673S. [Medline].

  78. St Geme JW, Murray DL, Carter J. Perinatal bacterial infection after prolonged rupture of amniotic membranes: an analysis of risk and management. J Pediatr. 1984 Apr. 104(4):608-13. [Medline].

  79. Rickert VI, Wiemann CM, Hankins GD, McKee JM, Berenson AB. Prevalence and risk factors of chorioamnionitis among adolescents. Obstet Gynecol. 1998 Aug. 92(2):254-7. [Medline].

  80. Jolly MC, Sebire N, Harris J, Robinson S, Regan L. Obstetric risks of pregnancy in women less than 18 years old. Obstet Gynecol. 2000 Dec. 96(6):962-6. [Medline].

  81. O'Brien RF. Bacterial vaginosis: many questions--any answers?. Curr Opin Pediatr. 2005 Aug. 17(4):473-9. [Medline].

  82. Raatikainen K, Heiskanen N, Verkasalo PK, Heinonen S. Good outcome of teenage pregnancies in high-quality maternity care. Eur J Public Health. 2006 Apr. 16(2):157-61. [Medline].

  83. Tran SH, Cheng YW, Kaimal AJ, Caughey AB. Length of rupture of membranes in the setting of premature rupture of membranes at term and infectious maternal morbidity. Am J Obstet Gynecol. 2008 Jun. 198(6):700.e1-5. [Medline].

  84. Nath CA, Ananth CV, Smulian JC, Shen-Schwarz S, Kaminsky L. Histologic evidence of inflammation and risk of placental abruption. Am J Obstet Gynecol. 2007 Sep. 197(3):319.e1-6. [Medline].

  85. Madan I, Romero R, Kusanovic JP, et al. The frequency and clinical significance of intra-amniotic infection and/or inflammation in women with placenta previa and vaginal bleeding: an unexpected observation. J Perinat Med. 2010 May. 38(3):275-9. [Medline].

  86. Bender L, Thaarup J, Varming K, Krarup H, Ellermann-Eriksen S, Ebbesen F. Early and late markers for the detection of early-onset neonatal sepsis. Dan Med Bull. 2008 Nov. 55(4):219-23. [Medline].

  87. Cetinkaya M, Ozkan H, Koksal N, Celebi S, Hacimustafaoglu M. Comparison of serum amyloid A concentrations with those of C-reactive protein and procalcitonin in diagnosis and follow-up of neonatal sepsis in premature infants. J Perinatol. 2009 Mar. 29(3):225-31. [Medline].

  88. Xiao Y, Griffin MP, Lake DE, Moorman JR. Nearest-neighbor and logistic regression analyses of clinical and heart rate characteristics in the early diagnosis of neonatal sepsis. Med Decis Making. 2010 Mar-Apr. 30(2):258-66. [Medline].

  89. Miller JM Jr, Kho MS, Brown HL, Gabert HA. Clinical chorioamnionitis is not predicted by an ultrasonic biophysical profile in patients with premature rupture of membranes. Obstet Gynecol. 1990 Dec. 76(6):1051-4. [Medline].

  90. Vintzileos AM, Campbell WA, Nochimson DJ. Fetal breathing as a predictor of infection in premature rupture of the membranes. Obstet Gynecol. 1986 Jun. 67(6):813-7. [Medline].

  91. Vintzileos AM, Campbell WA, Nochimson DJ. The fetal biophysical profile in patients with premature rupture of the membranes--an early predictor of fetal infection. Am J Obstet Gynecol. 1985 Jul 1. 152(5):510-6. [Medline].

  92. Paules C, Moreno E, Gonzales A, Fabre E, Gonzalez de Agüero R, Oros D. Amniotic fluid sludge as a marker of intra-amniotic infection and histological chorioamnionitis in cervical insufficiency: a report of four cases and literature review. J Matern Fetal Neonatal Med. 2015 Nov 9. 1-4. [Medline].

  93. Aina-Mumuney AJ, Althaus JE, Henderson JL, Blakemore MC, Johnson EA, Graham EM. Intrapartum electronic fetal monitoring and the identification of systemic fetal inflammation. J Reprod Med. 2007 Sep. 52(9):762-8. [Medline].

  94. Lieberman E, Lang JM, Frigoletto F Jr. Epidural analgesia, intrapartum fever, and neonatal sepsis evaluation. Pediatrics. 1997 Mar. 99(3):415-9. [Medline].

  95. Lieberman E, Lang J, Richardson DK. Intrapartum maternal fever and neonatal outcome. Pediatrics. 2000 Jan. 105(1 Pt 1):8-13. [Medline].

  96. Vallejo MC, Kaul B, Adler LJ. Chorioamnionitis, not epidural analgesia, is associated with maternal fever during labour. Can J Anaesth. 2001 Dec. 48(11):1122-6. [Medline].

  97. Leighton BL, Halpern SH. Epidural analgesia: effects on labor progress and maternal and neonatal outcome. Semin Perinatol. 2002 Apr. 26(2):122-35. [Medline].

  98. Goetzl L, Evans T, Rivers J. Elevated maternal and fetal serum interleukin-6 levels are associated with epidural fever. Am J Obstet Gynecol. 2002 Oct. 187(4):834-8. [Medline].

  99. Alexander JM. Epidural analgesia for labor pain and its relationship to fever. Clin Perinatol. 2005 Sep. 32(3):777-87. [Medline].

  100. Le Ray C, Audibert F, Goffinet F, Fraser W. When to stop pushing: effects of duration of second-stage expulsion efforts on maternal and neonatal outcomes in nulliparous women with epidural analgesia. Am J Obstet Gynecol. 2009 Oct. 201(4):361.e1-7. [Medline].

  101. Otsuki K, Yoda A, Saito H. Amniotic fluid lactoferrin in intrauterine infection. Placenta. 1999 Mar-Apr. 20(2-3):175-9. [Medline].

  102. Hein M, Valore EV, Helmig RB. Antimicrobial factors in the cervical mucus plug. Am J Obstet Gynecol. 2002 Jul. 187(1):137-44. [Medline].

  103. King AE, Critchley HO, Kelly RW. Innate immune defences in the human endometrium. Reprod Biol Endocrinol. 2003 Nov 28. 1:116. [Medline].

  104. Akinbi HT, Narendran V, Pass AK. Host defense proteins in vernix caseosa and amniotic fluid. Am J Obstet Gynecol. 2004 Dec. 191(6):2090-6. [Medline].

  105. Soto E, Espinoza J, Nien JK, et al. Human beta-defensin-2: a natural antimicrobial peptide present in amniotic fluid participates in the host response to microbial invasion of the amniotic cavity. J Matern Fetal Neonatal Med. 2007 Jan. 20(1):15-22. [Medline].

  106. Gomez R, Romero R, Nien JK. A short cervix in women with preterm labor and intact membranes: a risk factor for microbial invasion of the amniotic cavity. Am J Obstet Gynecol. 2005 Mar. 192(3):678-89. [Medline].

  107. Wilks M, Wiggins R, Whiley A. Identification and H(2)O(2) production of vaginal lactobacilli from pregnant women at high risk of preterm birth and relation with outcome. J Clin Microbiol. 2004 Feb. 42(2):713-7. [Medline].

  108. Balu RB, Savitz DA, Ananth CV. Bacterial vaginosis, vaginal fluid neutrophil defensins, and preterm birth. Obstet Gynecol. 2003 May. 101(5 Pt 1):862-8. [Medline].

  109. Simoes JA, Aroutcheva A, Heimler I. Bacteriocin susceptibility of Gardnerella vaginalis and its relationship to biotype, genotype, and metronidazole susceptibility. Am J Obstet Gynecol. 2001 Nov. 185(5):1186-90. [Medline].

  110. Reid G, Burton J. Use of Lactobacillus to prevent infection by pathogenic bacteria. Microbes Infect. 2002 Mar. 4(3):319-24. [Medline].

  111. McGaw T. Periodontal disease and preterm delivery of low-birth-weight infants. J Can Dent Assoc. 2002 Mar. 68(3):165-9. [Medline].

  112. Urban E, Radnai M, Novak T. Distribution of anaerobic bacteria among pregnant periodontitis patients who experience preterm delivery. Anaerobe. 2006 Feb. 12(1):52-7. [Medline].

  113. Matorras R, Garcia Perea A, Omenaca F, Usandizaga JA, Nieto A, Herruzo R. Group B streptococcus and premature rupture of membranes and preterm delivery. Gynecol Obstet Invest. 1989. 27(1):14-8. [Medline].

  114. Sanchez PJ, Regan JA. Vertical transmission of Ureaplasma urealyticum from mothers to preterm infants. Pediatr Infect Dis J. 1990 Jun. 9(6):398-401. [Medline].

  115. Spiegel CA. Bacterial vaginosis. Clin Microbiol Rev. 1991 Oct. 4(4):485-502. [Medline].

  116. Donder GG, Vereecken A, Bosmans E. Definition of a type of abnormal vaginal flora that is distinct from bacterial vaginosis: aerobic vaginitis. BJOG. 2002 Jan. 109(1):34-43. [Medline].

  117. Dixon NG, Ebright D, Defrancesco MA. Orogenital contact: a cause of chorioamnionitis?. Obstet Gynecol. 1994 Oct. 84(4 Pt 2):654-5. [Medline].

  118. Hansen LM, Dorsey TA, Batzer FA. Capnocytophaga chorioamnionitis after oral sex. Obstet Gynecol. 1996 Oct. 88(4 Pt 2):731. [Medline].

  119. Naeye RL, Ross S. Coitus and chorioamnionitis: a prospective study. Early Hum Dev. 1982 Jan. 6(1):91-7. [Medline].

  120. Yost NP, Owen J, Berghella V. Effect of coitus on recurrent preterm birth. Obstet Gynecol. 2006 Apr. 107(4):793-7. [Medline].

  121. Jones HE, Harris KA, Azizia M, et al. Differing prevalence and diversity of bacterial species in fetal membranes from very preterm and term labor. PLoS One. 2009 Dec 8. 4(12):e8205. [Medline]. [Full Text].

  122. Edwards RK, Novak-Weekley SM, Koty PP, Davis T, Leeds LJ, Jordan JA. Rapid group B streptococci screening using a real-time polymerase chain reaction assay. Obstet Gynecol. 2008 Jun. 111(6):1335-41. [Medline].

  123. Weinstein L. A multifacited approach to improve patient safety, prevent medical errors and resolve the professional liability crisis. Am J Obstet Gynecol. 2006 Apr. 194(4):1160-5; discussion 1165-7. [Medline].

  124. Donn SM. Medical liability, risk management, and the quality of health care. Semin Fetal Neonatal Med. 2005 Feb. 10(1):3-9. [Medline].

  125. Shwayder JM. Liability in high-risk obstetrics. Obstet Gynecol Clin North Am. 2007 Sep. 34(3):617-25, xiv. [Medline].

  126. Bonadio WA. Medical-legal considerations related to symptom duration and patient outcome after bacterial meningitis. Am J Emerg Med. 1997 Jul. 15(4):420-3. [Medline].

  127. Shalak LF, Laptook AR, Jafri HS. Clinical chorioamnionitis, elevated cytokines, and brain injury in term infants. Pediatrics. 2002 Oct. 110(4):673-80. [Medline].

  128. Grether JK, Nelson KB, Walsh E. Intrauterine exposure to infection and risk of cerebral palsy in very preterm infants. Arch Pediatr Adolesc Med. 2003 Jan. 157(1):26-32. [Medline].

  129. Graham EM, Holcroft CJ, Rai KK. Neonatal cerebral white matter injury in preterm infants is associated with culture positive infections and only rarely with metabolic acidosis. Am J Obstet Gynecol. 2004 Oct. 191(4):1305-10. [Medline].

  130. Seubert DE, Huang WM, Wasserman-Hoff R. Medical legal issues in the prevention of prematurity. Clin Perinatol. 2007 Jun. 34(2):309-18, vii. [Medline].

  131. Yancey MK, Zhang J, Schwarz J, Dietrich CS 3rd, Klebanoff M. Labor epidural analgesia and intrapartum maternal hyperthermia. Obstet Gynecol. 2001 Nov. 98(5 Pt 1):763-70. [Medline].

  132. Mantha VR, Vallejo MC, Ramesh V, Phelps AL, Ramanathan S. The incidence of maternal fever during labor is less with intermittent than with continuous epidural analgesia: a randomized controlled trial. Int J Obstet Anesth. 2008 Apr. 17(2):123-9. [Medline].

  133. Riley LE, Celi AC, Onderdonk AB, Roberts DJ, Johnson LC, Tsen LC, et al. Association of epidural-related fever and noninfectious inflammation in term labor. Obstet Gynecol. 2011 Mar. 117(3):588-95. [Medline].

  134. Impey L, Greenwood C, MacQuillan K, Reynolds M, Sheil O. Fever in labour and neonatal encephalopathy: a prospective cohort study. BJOG. 2001 Jun. 108(6):594-7. [Medline].

  135. Goldenberg RL, Andrews WW, Goepfert AR, et al. The Alabama Preterm Birth Study: umbilical cord blood Ureaplasma urealyticum and Mycoplasma hominis cultures in very preterm newborn infants. Am J Obstet Gynecol. 2008 Jan. 198(1):43.e1-5. [Medline].

  136. Payne MS, Goss KC, Connett GJ, et al. Molecular microbiological characterization of preterm neonates at risk of bronchopulmonary dysplasia. Pediatr Res. 2010 Apr. 67(4):412-8. [Medline].

  137. Andrews WW, Hauth JC, Cliver SP, Savage K, Goldenberg RL. Randomized clinical trial of extended spectrum antibiotic prophylaxis with coverage for Ureaplasma urealyticum to reduce post-cesarean delivery endometritis. Obstet Gynecol. 2003 Jun. 101(6):1183-9. [Medline].

  138. Matlow A, Th'ng C, Kovach D, Quinn P, Dunn M, Wang E. Susceptibilities of neonatal respiratory isolates of Ureaplasma urealyticum to antimicrobial agents. Antimicrob Agents Chemother. 1998 May. 42(5):1290-2. [Medline].

  139. Figueroa R, Garry D, Elimian A. Evaluation of amniotic fluid cytokines in preterm labor and intact membranes. J Matern Fetal Neonatal Med. 2005 Oct. 18(4):241-7. [Medline].

  140. Volante E, Moretti S, Pisani F. Early diagnosis of bacterial infection in the neonate. J Matern Fetal Neonatal Med. 2004 Nov. 16 Suppl 2:13-6. [Medline].

  141. Kayem G, Goffinet F, Batteux F. Detection of interleukin-6 in vaginal secretions of women with preterm premature rupture of membranes and its association with neonatal infection: a rapid immunochromatographic test. Am J Obstet Gynecol. 2005 Jan. 192(1):140-5. [Medline].

  142. Chaemsaithong P, Romero R, Korzeniewski SJ, et al. A rapid interleukin-6 bedside test for the identification of intra-amniotic inflammation in preterm labor with intact membranes. J Matern Fetal Neonatal Med. 2016 Feb. 29 (3):349-59. [Medline].

  143. Chaemsaithong P, Romero R, Korzeniewski SJ, et al. A point of care test for interleukin-6 in amniotic fluid in preterm prelabor rupture of membranes: a step toward the early treatment of acute intra-amniotic inflammation/infection. J Matern Fetal Neonatal Med. 2016 Feb. 29 (3):360-7. [Medline].

  144. Straka M, Dela Cruz W, Blackmon C. Rapid detection of group B streptococcus and Escherichia coli in amniotic fluid using real-time fluorescent PCR. Infect Dis Obstet Gynecol. 2004 Sep-Dec. 12(3-4):109-14. [Medline].

  145. Akers A, Jarzembowski JA, Johnson CT, Lieberman RW, Dalton VK. Examining the relationship between positive mid-gestational fetal fibronectin assays and histological evidence of acute placental inflammation. J Perinat Med. 2007. 35(1):36-42. [Medline].

  146. [Guideline] Perinatal group B streptococcal disease after universal screening recommendations--United States, 2003-2005. MMWR Morb Mortal Wkly Rep. 2007 Jul 20. 56(28):701-5. [Medline].

  147. Elvedi-Gasparovic V, Peter B. Maternal group B streptococcus infection, neonatal outcome and the role of preventive strategies. Coll Antropol. 2008 Mar. 32(1):147-51. [Medline].

  148. Daniels J, Gray J, Pattison H, et al. Rapid testing for group B streptococcus during labour: a test accuracy study with evaluation of acceptability and cost-effectiveness. Health Technol Assess. 2009 Sep. 13(42):1-154, iii-iv. [Medline].

  149. Pulver LS, Hopfenbeck MM, Young PC, et al. Continued early onset group B streptococcal infections in the era of intrapartum prophylaxis. J Perinatol. 2009 Jan. 29(1):20-5. [Medline].

  150. Benitz WE, Gould JB, Druzin ML. Preventing early-onset group B streptococcal sepsis: strategy development using decision analysis. Pediatrics. 1999 Jun. 103(6):e76. [Medline].

  151. Akker-van Marle ME, Rijnders ME, Dommelen P, et al. Cost-effectiveness of different treatment strategies with intrapartum antibiotic prophylaxis to prevent early-onset group B streptococcal disease. BJOG. 2005 Jun. 112(6):820-6. [Medline].

  152. Shim SS, Romero R, Jun JK. C-reactive protein concentration in vaginal fluid as a marker for intra-amniotic inflammation/infection in preterm premature rupture of membranes. J Matern Fetal Neonatal Med. 2005 Dec. 18(6):417-22. [Medline].

  153. Wiwanitkit V. Maternal C-reactive protein for detection of chorioamnionitis: an appraisal. Infect Dis Obstet Gynecol. 2005 Sep. 13(3):179-81. [Medline].

  154. Visser VE, Hall RT. Urine culture in the evaluation of suspected neonatal sepsis. J Pediatr. 1979 Apr. 94(4):635-8. [Medline].

  155. Sherman MP, Chance KH, Goetzman BW. Gram's stains of tracheal secretions predict neonatal bacteremia. Am J Dis Child. 1984 Sep. 138(9):848-50. [Medline].

  156. Wiswell TE, Baumgart S, Gannon CM. No lumbar puncture in the evaluation for early neonatal sepsis: will meningitis be missed?. Pediatrics. 1995 Jun. 95(6):803-6. [Medline].

  157. Sherman MP, Goetzman BW, Ahlfors CE. Tracheal asiration and its clinical correlates in the diagnosis of congenital pneumonia. Pediatrics. 1980 Feb. 65(2):258-63. [Medline].

  158. Manroe BL, Rosenfeld CR, Weinberg AG. The differential leukocyte count in the assessment and outcome of early-onset neonatal group B streptococcal disease. J Pediatr. 1977 Oct. 91(4):632-7. [Medline].

  159. Manroe BL, Weinberg AG, Rosenfeld CR. The neonatal blood count in health and disease. I. Reference values for neutrophilic cells. J Pediatr. 1979 Jul. 95(1):89-98. [Medline].

  160. Cornbleet PJ. Clinical utility of the band count. Clin Lab Med. 2002 Mar. 22(1):101-36. [Medline].

  161. Christensen RD, Henry E, Wiedmeier SE, Stoddard RA, Lambert DK. Low blood neutrophil concentrations among extremely low birth weight neonates: data from a multihospital health-care system. J Perinatol. 2006 Nov. 26(11):682-7. [Medline].

  162. Christensen RD. Morphology and concentration of circulating neutrophils in neonates with bacterial sepsis. Pediatr Infect Dis J. 1987 May. 6(5):429-30. [Medline].

  163. Christensen RD, Rothstein G, Anstall HB, Bybee B. Granulocyte transfusions in neonates with bacterial infection, neutropenia, and depletion of mature marrow neutrophils. Pediatrics. 1982 Jul. 70(1):1-6. [Medline].

  164. Benitz WE, Han MY, Madan A. Serial serum C-reactive protein levels in the diagnosis of neonatal infection. Pediatrics. 1998 Oct. 102(4):e41. [Medline].

  165. Ng PC, Li G, Chui KM, et al. Neutrophil CD64 is a sensitive diagnostic marker for early-onset neonatal infection. Pediatr Res. 2004 Nov. 56(5):796-803. [Medline].

  166. Ng PC, Li G, Chui KM, et al. Quantitative measurement of monocyte HLA-DR expression in the identification of early-onset neonatal infection. Biol Neonate. 2006. 89(2):75-81. [Medline].

  167. Mishra UK, Jacobs SE, Doyle LW, Garland SM. Newer approaches to the diagnosis of early onset neonatal sepsis. Arch Dis Child Fetal Neonatal Ed. 2006 May. 91(3):F208-12. [Medline].

  168. Brozanski BS, Jones JG, Krohn MJ, Jordan JA. Use of polymerase chain reaction as a diagnostic tool for neonatal sepsis can result in a decrease in use of antibiotics and total neonatal intensive care unit length of stay. J Perinatol. 2006 Nov. 26(11):688-92. [Medline].

  169. Makhoul IR, Sprecher H, Smolkin T, Sawaid R, Ben-David S, Sujov P, et al. Approach to term neonates born after maternal intrapartum fever and unknown maternal group B Streptococcus status: value of serum C-reactive protein and 16S rRNA gene PCR amplification. Pediatr Infect Dis J. 2007 Nov. 26(11):1064-6. [Medline].

  170. Ohlin A, Backman A, Bjorkqvist M, Molling P, Jurstrand M, Schollin J. Real-time PCR of the 16S-rRNA gene in the diagnosis of neonatal bacteraemia. Acta Paediatr. 2008 Oct. 97(10):1376-80. [Medline].

  171. Sherer DM, Spong CY, Salafia CM. Fetal breathing movements within 24 hours of delivery in prematurity are related to histologic and clinical evidence of amnionitis. Am J Perinatol. 1997 Jul. 14(6):337-40. [Medline].

  172. Ghidini A, Salafia CM, Kirn V. Biophysical profile in predicting acute ascending infection in preterm rupture of membranes before 32 weeks. Obstet Gynecol. 2000 Aug. 96(2):201-6. [Medline].

  173. Heller DS, Rimpel LH, Skurnick JH. Does histologic chorioamnionitis correspond to clinical chorioamnionitis?. J Reprod Med. 2008 Jan. 53(1):25-8. [Medline].

  174. Redline RW, Faye-Petersen O, Heller D, Qureshi F, Savell V, Vogler C. Amniotic infection syndrome: nosology and reproducibility of placental reaction patterns. Pediatr Dev Pathol. 2003 Sep-Oct. 6(5):435-48. [Medline].

  175. Lim L, Rozycki HJ. Postnatal SNAP-II scores in neonatal intensive care unit patients: relationship to sepsis, necrotizing enterocolitis, and death. J Matern Fetal Neonatal Med. 2008 Jun. 21(6):415-9. [Medline].

  176. Winn HN. Group B streptococcus infection in pregnancy. Clin Perinatol. 2007 Sep. 34(3):387-92. [Medline].

  177. Schrag SJ, Zell ER, Lynfield R. A population-based comparison of strategies to prevent early-onset group B streptococcal disease in neonates. N Engl J Med. 2002 Jul 25. 347(4):233-9. [Medline].

  178. [Guideline] Schrag S, Gorwitz R, Fultz-Butts K, Schuchat A. Prevention of perinatal group B streptococcal disease. Revised guidelines from CDC. MMWR Recomm Rep. 2002 Aug 16. 51:1-22. [Medline]. [Full Text].

  179. Buchanan SL, Crowther CA, Levett KM, Middleton P, Morris J. Planned early birth versus expectant management for women with preterm prelabour rupture of membranes prior to 37 weeks' gestation for improving pregnancy outcome. Cochrane Database Syst Rev. 2010 Mar 17. 3:CD004735. [Medline].

  180. Abou El Senoun G, Dowswell T, Mousa HA. Planned home versus hospital care for preterm prelabour rupture of the membranes (PPROM) prior to 37 weeks' gestation. Cochrane Database Syst Rev. 2010 Apr 14. 4:CD008053. [Medline].

  181. Amstey MS, Gibbs RS. Is penicillin G a better choice than ampicillin for prophylaxis of neonatal group B streptococcal infections?. Obstet Gynecol. 1994 Dec. 84(6):1058-9. [Medline].

  182. Apgar BS, Greenberg G, Yen G. Prevention of group B streptococcal disease in the newborn. Am Fam Physician. 2005 Mar 1. 71(5):903-10. [Medline].

  183. Alarcon A, Pena P, Salas S, et al. Neonatal early onset Escherichia coli sepsis: trends in incidence and antimicrobial resistance in the era of intrapartum antimicrobial prophylaxis. Pediatr Infect Dis J. 2004 Apr. 23(4):295-9. [Medline].

  184. Gibbs RS, Schrag S, Schuchat A. Perinatal infections due to group B streptococci. Obstet Gynecol. 2004 Nov. 104(5 Pt 1):1062-76. [Medline].

  185. Schelonka RL, Infante AJ. Neonatal immunology. Semin Perinatol. 1998 Feb. 22(1):2-14. [Medline].

  186. Suri M, Harrison L, Van de Ven C, Cairo MS. Immunotherapy in the prophylaxis and treatment of neonatal sepsis. Curr Opin Pediatr. 2003 Apr. 15(2):155-60. [Medline].

  187. Shaw CK, Thapalial A, Shaw P, Malla K. Intravenous immunoglobulins and haematopoietic growth factors in the prevention and treatment of neonatal sepsis: ground reality or glorified myths?. Int J Clin Pract. 2007 Mar. 61(3):482-7. [Medline].

  188. Ohlsson A, Lacy J. Intravenous immunoglobulin for suspected or subsequently proven infection in neonates. Cochrane Database Syst Rev. 2010 Mar 17. 3:CD001239. [Medline].

  189. Boggess KA. Pathophysiology of preterm birth: emerging concepts of maternal infection. Clin Perinatol. 2005 Sep. 32(3):561-9. [Medline].

  190. Shennan A, Crawshaw S, Briley A. A randomised controlled trial of metronidazole for the prevention of preterm birth in women positive for cervicovaginal fetal fibronectin: the PREMET Study. BJOG. 2006 Jan. 113(1):65-74. [Medline].

  191. Berger A, Witt A, Haiden N, et al. Intrauterine infection with Ureaplasma species is associated with adverse neuromotor outcome at 1 and 2 years adjusted age in preterm infants. J Perinat Med. 2009. 37(1):72-8. [Medline].

  192. Borchardt SM, DeBusscher JH, Tallman PA, et al. Frequency of antimicrobial resistance among invasive and colonizing Group B streptococcal isolates. BMC Infect Dis. 2006 Mar 20. 6:57. [Medline].

  193. Phares CR, Lynfield R, Farley MM, et al. Epidemiology of invasive group B streptococcal disease in the United States, 1999-2005. JAMA. 2008 May 7. 299(17):2056-65. [Medline].

  194. Bayraktar MR, Ozerol IH, Gucluer N, Celik O. Prevalence and antibiotic susceptibility of Mycoplasma hominis and Ureaplasma urealyticum in pregnant women. Int J Infect Dis. 2010 Feb. 14(2):e90-5. [Medline].

  195. Kartali G, Tzelepi E, Pournaras S, et al. Outbreak of infections caused by Enterobacter cloacae producing the integron-associated beta-lactamase IBC-1 in a neonatal intensive care unit of a Greek hospital. Antimicrob Agents Chemother. 2002 May. 46(5):1577-80. [Medline]. [Full Text].

  196. Young TE, Mangum B. Antimicrobials. NEOFAX 2009. 22nd Edition. Montvale, NJ: Thomson Reuters; 2009. 1-89.

  197. Speer CP. Pulmonary inflammation and bronchopulmonary dysplasia. J Perinatol. 2006 May. 26 Suppl 1:S57-62; discussion S63-4. [Medline].

  198. Ryan RM, Ahmed Q, Lakshminrusimha S. Inflammatory mediators in the immunobiology of bronchopulmonary dysplasia. Clin Rev Allergy Immunol. 2008 Apr. 34(2):174-90. [Medline].

  199. Getahun D, Strickland D, Zeiger RS, et al. Effect of chorioamnionitis on early childhood asthma. Arch Pediatr Adolesc Med. 2010 Feb. 164(2):187-92. [Medline].

  200. ACOG Statement. ACOG practice bulletin. Premature rupture of membranes. Clinical management guidelines for obstetrician-gynecologists. Number 1, June 1998. American College of Obstetricians and Gynecologists. Int J Gynaecol Obstet. 1998 Oct. 63(1):75-84. [Medline].

  201. Alanen A. Polymerase chain reaction in the detection of microbes in amniotic fluid. Ann Med. 1998 Jun. 30(3):288-95. [Medline].

  202. Andrews WW, Cliver SP, Biasini F, et al. Early preterm birth: association between in utero exposure to acute inflammation and severe neurodevelopmental disability at 6 years of age. Am J Obstet Gynecol. 2008 Apr. 198(4):466.e1-466.e11. [Medline].

  203. Badri MS, Zawaneh S, Cruz AC. Rectal colonization with group B streptococcus: relation to vaginal colonization of pregnant women. J Infect Dis. 1977 Feb. 135(2):308-12. [Medline].

  204. Benitz WE, Gould JB, Druzin ML. Risk factors for early-onset group B streptococcal sepsis: estimation of odds ratios by critical literature review. Pediatrics. 1999 Jun. 103(6):e77. [Medline].

  205. Berger C, Uehlinger J, Ghelfi D. Comparison of C-reactive protein and white blood cell count with differential in neonates at risk for septicemia. Eur J Pediatr. 1995 Feb. 154(2):138-44. [Medline].

  206. Bint AJ, Hill D. Bacteriuria of pregnancy--an update on significance, diagnosis and management. J Antimicrob Chemother. 1994 May. 33 Suppl A:93-7. [Medline].

  207. Boggess KA, Trevett TN, Madianos PN. Use of DNA hybridization to detect vaginal pathogens associated with bacterial vaginosis among asymptomatic pregnant women. Am J Obstet Gynecol. 2005 Sep. 193(3 Pt 1):752-6. [Medline].

  208. Brocklehurst P. Infection and preterm delivery. BMJ. 1999 Feb 27. 318(7183):548-9. [Medline].

  209. Carey JC, Klebanoff MA, Hauth JC. Metronidazole to prevent preterm delivery in pregnant women with asymptomatic bacterial vaginosis. National Institute of Child Health and Human Development Network of Maternal-Fetal Medicine Units. N Engl J Med. 2000 Feb 24. 342(8):534-40. [Medline].

  210. Christensen RD, Rothstein G, Hill HR. Fatal early onset group B streptococcal sepsis with normal leukocyte counts. Pediatr Infect Dis. 1985 May-Jun. 4(3):242-5. [Medline].

  211. Churgay CA, Smith MA, Blok B. Maternal fever during labor--what does it mean?. J Am Board Fam Pract. 1994 Jan-Feb. 7(1):14-24. [Medline].

  212. Dashe JS, Rogers BB, McIntire DD. Epidural analgesia and intrapartum fever: placental findings. Obstet Gynecol. 1999 Mar. 93(3):341-4. [Medline].

  213. Dobson SR, Isaacs D, Wilkinson AR. Reduced use of surface cultures for suspected neonatal sepsis and surveillance. Arch Dis Child. 1992 Jan. 67(1 Spec No):44-7. [Medline].

  214. Dudley DJ. Immunoendocrinology of preterm labor: the link between corticotropin-releasing hormone and inflammation. Am J Obstet Gynecol. 1999 Jan. 180(1 Pt 3):S251-6. [Medline].

  215. Espinoza J, Chaiworapongsa T, Romero R. Antimicrobial peptides in amniotic fluid: defensins, calprotectin and bacterial/permeability-increasing protein in patients with microbial invasion of the amniotic cavity, intra-amniotic inflammation, preterm labor and premature rupture of membranes. J Matern Fetal Neonatal Med. 2003 Jan. 13(1):2-21. [Medline].

  216. Garcia-Prats JA, Cooper TR, Schneider VF. Rapid detection of microorganisms in blood cultures of newborn infants utilizing an automated blood culture system. Pediatrics. 2000 Mar. 105(3 Pt 1):523-7. [Medline].

  217. Garite TJ, Freeman RK. Chorioamnionitis in the preterm gestation. Obstet Gynecol. 1982 May. 59(5):539-45. [Medline].

  218. Gibbs RS, Davies JK, McDuffie RS Jr. Chronic intrauterine infection and inflammation in the preterm rabbit, despite antibiotic therapy. Am J Obstet Gynecol. 2002 Feb. 186(2):234-9. [Medline].

  219. Gibbs RS, Duff P. Progress in pathogenesis and management of clinical intraamniotic infection. Am J Obstet Gynecol. 1991 May. 164(5 Pt 1):1317-26. [Medline].

  220. Gilstrap LC 3d, Leveno KJ, Cox SM. Intrapartum treatment of acute chorioamnionitis: impact on neonatal sepsis. Am J Obstet Gynecol. 1988 Sep. 159(3):579-83. [Medline].

  221. Goldenberg RL, Hauth JC, Andrews WW. Intrauterine infection and preterm delivery. N Engl J Med. 2000 May 18. 342(20):1500-7. [Medline].

  222. Goldenberg RL, Mercer BM, Miodovnik M. Plasma ferritin, premature rupture of membranes, and pregnancy outcome. Am J Obstet Gynecol. 1998 Dec. 179(6 Pt 1):1599-604. [Medline].

  223. Goldenberg RL, Mwatha A, Read JS. The HPTN 024 Study: the efficacy of antibiotics to prevent chorioamnionitis and preterm birth. Am J Obstet Gynecol. 2006 Mar. 194(3):650-61. [Medline].

  224. Gomez R, Ghezzi F, Romero R. Premature labor and intra-amniotic infection. Clinical aspects and role of the cytokines in diagnosis and pathophysiology. Clin Perinatol. 1995 Jun. 22(2):281-342. [Medline].

  225. Gonzalez-Bosquet E, Cerqueira MJ, Dominguez C. Amniotic fluid glucose and cytokines values in the early diagnosis of amniotic infection in patients with preterm labor and intact membranes. J Matern Fetal Med. 1999 Jul-Aug. 8(4):155-8. [Medline].

  226. Hachey WE, Wiswell TE. Limitations in the usefulness of urine latex particle agglutination tests and hematologic measurements in diagnosing neonatal sepsis during the first week of life. J Perinatol. 1992 Sep. 12(3):240-5. [Medline].

  227. Hauth JC, Gilstrap LC 3d, Hankins GD. Term maternal and neonatal complications of acute chorioamnionitis. Obstet Gynecol. 1985 Jul. 66(1):59-62. [Medline].

  228. Heighton BL, Halpren SH. The effects of epidural analgesia on labor, maternal, and neonatal outcomes: a systematic review. Am J Obstet Gynecol. 2002. 186(5 Suppl Nature):S69-77.

  229. Hemming VG, McCloskey DW, Hill HR. Pneumonia in the neonate associated with group B streptococcal septicemia. Am J Dis Child. 1976 Nov. 130(11):1231-3. [Medline].

  230. Hillier SL, Martius J, Krohn M. A case-control study of chorioamnionic infection and histologic chorioamnionitis in prematurity. N Engl J Med. 1988 Oct 13. 319(15):972-8. [Medline].

  231. Hussey MJ, Levy ES, Pombar X. Evaluating rapid diagnostic tests of intra-amniotic infection: Gram stain, amniotic fluid glucose level, and amniotic fluid to serum glucose level ratio. Am J Obstet Gynecol. 1998 Sep. 179(3 Pt 1):650-6. [Medline].

  232. Ismail MA, Zinaman MJ, Lowensohn RI. The significance of C-reactive protein levels in women with premature rupture of membranes. Am J Obstet Gynecol. 1985 Feb 15. 151(4):541-4. [Medline].

  233. Johnson CE, Whitwell JK, Pethe K. Term newborns who are at risk for sepsis: are lumbar punctures necessary?. Pediatrics. 1997 Apr. 99(4):e10. [Medline].

  234. Joseph TA, Pyati SP, Jacobs N. Neonatal early-onset Escherichia coli disease. The effect of intrapartum ampicillin. Arch Pediatr Adolesc Med. 1998 Jan. 152(1):35-40. [Medline].

  235. Kaftan H, Kinney JS. Early onset neonatal bacterial infections. Semin Perinatol. 1998 Feb. 22(1):15-24. [Medline].

  236. Kurlat I, Stoll BJ, McGowan JE Jr. Time to positivity for detection of bacteremia in neonates. J Clin Microbiol. 1989 May. 27(5):1068-71. [Medline].

  237. Maeda K, Matsuzaki N, Fuke S. Value of the maternal interleukin 6 level for determination of histologic chorioamnionitis in preterm delivery. Gynecol Obstet Invest. 1997. 43(4):225-31. [Medline].

  238. Mangurten HH, Angst DB, See C, Boyle D, Beckman S. Professional liability in a neonatal intensive care unit: a review of 20 years' experience. J Perinatol. 2000 Jun. 20(4):244-8. [Medline].

  239. Mercer BM, Lewis R. Preterm labor and preterm premature rupture of the membranes. Diagnosis and management. Infect Dis Clin North Am. 1997 Mar. 11(1):177-201. [Medline].

  240. Miura E, Procianoy RS, Bittar C. A randomized, double-masked, placebo-controlled trial of recombinant granulocyte colony-stimulating factor administration to preterm infants with the clinical diagnosis of early-onset sepsis. Pediatrics. 2001 Jan. 107(1):30-5. [Medline].

  241. Moore SE, Cole TJ, Collinson AC. Prenatal or early postnatal events predict infectious deaths in young adulthood in rural Africa. Int J Epidemiol. 1999 Dec. 28(6):1088-95. [Medline].

  242. Murtha AP, Greig PC, Jimmerson CE. Maternal serum interleukin-6 concentrations in patients with preterm premature rupture of membranes and evidence of infection. Am J Obstet Gynecol. 1996 Oct. 175(4 Pt 1):966-9. [Medline].

  243. Nasef N, Shabaan AE, Schurr P, Iaboni D, Choudhury J, Church P, et al. Effect of clinical and histological chorioamnionitis on the outcome of preterm infants. Am J Perinatol. 2013 Jan. 30(1):59-68. [Medline].

  244. Ohlsson A, Lacy JB. Intravenous immunoglobulin for suspected or subsequently proven infection in neonates. Cochrane Database Syst Rev. 2004. CD001239. [Medline].

  245. Philip J, Alexander JM, Sharma SK. Epidural analgesia during labor and maternal fever. Anesthesiology. 1999 May. 90(5):1271-5. [Medline].

  246. Pourcyrous M, Bada HS, Korones SB. Significance of serial C-reactive protein responses in neonatal infection and other disorders. Pediatrics. 1993 Sep. 92(3):431-5. [Medline].

  247. Puopolo KM. Bacterial and fungal infections. Cloherty JP, Eichenwald EC, Stark AR, eds. Manual of Neonatal Care. 5th ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2004. 287-313.

  248. Romem Y, Artal R. C-reactive protein as a predictor for chorioamnionitis in cases of premature rupture of the membranes. Am J Obstet Gynecol. 1984 Nov 1. 150(5 Pt 1):546-50. [Medline].

  249. Sanghvi KP, Tudehope DI. Neonatal bacterial sepsis in a neonatal intensive care unit: a 5 year analysis. J Paediatr Child Health. 1996 Aug. 32(4):333-8. [Medline].

  250. Schmutz N, Henry E, Jopling J, Christensen RD. Expected ranges for blood neutrophil concentrations of neonates: the Manroe and Mouzinho charts revisited. J Perinatol. 2008 Apr. 28(4):275-81. [Medline].

  251. Schuchat A, Zywicki SS, Dinsmoor MJ. Risk factors and opportunities for prevention of early-onset neonatal sepsis: a multicenter case-control study. Pediatrics. 2000 Jan. 105(1 Pt 1):21-6. [Medline].

  252. Seaward PG, Hannah ME, Myhr TL. International multicenter term PROM study: evaluation of predictors of neonatal infection in infants born to patients with premature rupture of membranes at term. Premature Rupture of the Membranes. Am J Obstet Gynecol. 1998 Sep. 179(3 Pt 1):635-9. [Medline].

  253. Seo K, McGregor JA, French JI. Preterm birth is associated with increased risk of maternal and neonatal infection. Obstet Gynecol. 1992 Jan. 79(1):75-80. [Medline].

  254. Sherman MP. Macrophage function in bacterial and fungal infections of newborns. In: Lipscomb MF, Russell SW, eds. Lung macrophages and dendritic cells. Lung Biology in Health and Disease Series. Vol 102. New York, NY:. Marcel Dekker. 1997:409-436.

  255. Smulian JC, Shen-Schwarz S, Vintzileos AM. Clinical chorioamnionitis and histologic placental inflammation. Obstet Gynecol. 1999 Dec. 94(6):1000-5. [Medline].

  256. Smulian JC, Vintzileos AM, Lai YL. Maternal chorioamnionitis and umbilical vein interleukin-6 levels for identifying early neonatal sepsis. J Matern Fetal Med. 1999 May-Jun. 8(3):88-94. [Medline].

  257. Sreenan C, Osiovich H. Myeloid colony-stimulating factors: use in the newborn. Arch Pediatr Adolesc Med. 1999 Sep. 153(9):984-8. [Medline].

  258. Stoll BJ, Hansen N, Fanaroff AA. Changes in pathogens causing early-onset sepsis in very-low-birth- weight infants. N Engl J Med. 2002 Jul 25. 347(4):240-7. [Medline].

  259. Stoll BJ, Holman RC, Schuchat A. Decline in sepsis-associated neonatal and infant deaths in the United States, 1979 through 1994. Pediatrics. 1998 Aug. 102(2):e18. [Medline].

  260. Teichmann AT, Arendt P, Speer CP. Premature rupture of the membranes and amniotic infections--the significance of laboratory tests. Eur J Obstet Gynecol Reprod Biol. 1990 Mar. 34(3):217-22. [Medline].

  261. Terrone DA, Rinehart BK, Einstein MH. Neonatal sepsis and death caused by resistant Escherichia coli: possible consequences of extended maternal ampicillin administration. Am J Obstet Gynecol. 1999 Jun. 180(6 Pt 1):1345-8. [Medline].

  262. Towers CV, Carr MH, Padilla G. Potential consequences of widespread antepartal use of ampicillin. Am J Obstet Gynecol. 1998 Oct. 179(4):879-83. [Medline].

  263. Vollman JH, Smith WL, Ballard ET. Early onset group B streptococcal disease: clinical, roentgenographic, and pathologic features. J Pediatr. 1976 Aug. 89(2):199-203. [Medline].

  264. Wolach B. Neonatal sepsis: pathogenesis and supportive therapy. Semin Perinatol. 1997 Feb. 21(1):28-38. [Medline].

  265. Yoon BH, Jun JK, Romero R. Amniotic fluid inflammatory cytokines (interleukin-6, interleukin-1beta, and tumor necrosis factor-alpha), neonatal brain white matter lesions, and cerebral palsy. Am J Obstet Gynecol. 1997 Jul. 177(1):19-26. [Medline].

  266. Yoon BH, Romero R, Lim JH. The clinical significance of detecting Ureaplasma urealyticum by the polymerase chain reaction in the amniotic fluid of patients with preterm labor. Am J Obstet Gynecol. 2003 Oct. 189(4):919-24. [Medline].

  267. Yoon BH, Romero R, Shim JY. C-reactive protein in umbilical cord blood: a simple and widely available clinical method to assess the risk of amniotic fluid infection and funisitis. J Matern Fetal Neonatal Med. 2003 Aug. 14(2):85-90. [Medline].

  268. Yoon BH, Yang SH, Jun JK. Maternal blood C-reactive protein, white blood cell count, and temperature in preterm labor: a comparison with amniotic fluid white blood cell count. Obstet Gynecol. 1996 Feb. 87(2):231-7. [Medline].

  269. Hassell KJ, Ezzati M, Alonso-Alconada D, Hausenloy DJ, Robertson NJ. New horizons for newborn brain protection: enhancing endogenous neuroprotection. Arch Dis Child Fetal Neonatal Ed. 2015 Nov. 100 (6):F541-52. [Medline].

  270. Taguchi A, Yamashita A, Kawana K, et al. Recent progress in therapeutics for inflammation-associated preterm birth: a review. Reprod Sci. 2015 Dec 1. [Medline].

 
Previous
Next
 
 
 
 
All material on this website is protected by copyright, Copyright © 1994-2016 by WebMD LLC. This website also contains material copyrighted by 3rd parties.