Chorioamnionitis: epidemiology of newborn management and outcome United States 2008

OBJECTIVE: Current American Academy of Pediatric recommendations call for the empirical use of antibiotics for all well-appearing term newborn infants born to women given a diagnosis of chorioamnionitis. The objective of this analysis was to determine among term infants (37-42 weeks gestation) the prevalence of exposure to clinical chorioamnionitis, intrapartum antibiotics, infant antibiotic use and neonatal intensive care unit (NICU) admission and the relationship of these risk factors to neonatal mortality. STUDY DESIGN: United States-linked infant birth and death certificate files for the year 2008 were used Maternal demographic variables, labor and delivery risk factors and infant characteristics were analyzed for associations with a reported diagnosis of chorioamnionitis and neonatal death, NICU admission and antibiotic usage. RESULT: There were 2 281 386 births available with information on the diagnosis of chorioamnionitis. The prevalence of chorioamnionitis in this population was 9.7 per 1000 live births (LB) and the neonatal mortality rate for exposed infants was 1.40/1000 LB vs 0.81/1000 LB for infants without chorioamnionitis, odds ratio (OR) = 1.72, 95% confidence interval 1.20-2.45. The OR for neonatal death for infants with chorioamnionitis exposure who received antibiotics vs those who did not was 0.69 (95% confidence interval = 0.21-2.26). CONCLUSION: Exposure to chorioamnionitis is associated with an increased risk of neonatal mortality. Guidelines for treatment of infants exposed to chorioamnionitis with antibiotics are followed in only a small proportion of such cases.