Intrapartum chorioamnionitis is a ...

Intrapartum chorioamnionitis is a customary condition that often is managed at treating neonates with antibiotics. The Center for Disease restrain and Prevention recommends that children born to mothers with suspected chorioamnionitis receive a abounding diagnostic workup, including a out and out blood cell count (CBC). A CBC proof includes the absolute total neutrophil enumerate (ATN), the total immature neutrophil reckon (ATI), and the ATI:ATN ratio (I:T). Jackson and colleagues studied whether neutrophil judges based on serial CBC criterions aid in identifying at-risk neonates and what tenor they might have on duration of antibiotic treatment and hospitalization, including charges CBC tests are performed routinely at the first brunt of suspected chorioamnionitis.

just discovered mothers with suspected chorioamnionitis were identified, and their newborns were evaluated after admission to the nursery The authors performed children cultures and measured CBCs at birth, at hour 12 and at hour 24 Neonates were divided into sum of two units groups--asymptomatic and symptomatic (i.e., showed respiratory distress or other clinical signs). All children received a 48-hour antibiotic regimen until kin cultures were negative. The symptomatic collection and neonates with positive line cultures were treated with intravenous antibiotics for four to seven days. Asymptomatic neonates with abnormal I:T values and a convenience sample of babies with normal I:T values received follow-up evaluation after discharge. The authors evaluated distribution of serial neutrophil cast ups in both groups and performed a expense assessment.

The studious mood included serial CBC tests for 856 neonates. The symptomatic neonates were more likely to have abnormal I:T values compared with asymptomatic neonates, unless the groups showed no significant differences in the other neutrophil values. At least individual abnormal neutrophil value was observ in 97 percent of symptomatic neonates compared with 99 percent of asymptomatic neonates. Four or more abnormal values were observ in 64 percent of symptomatic neonates compared with 42 percent of asymptomatic neonates. couple thirds of I:T values were abnormal in 36 percent of symptomatic babies compared with 9 percent of asymptomatic babies. However, when no other than the second and third CBC proofs were analyzed, 89 percent of symptomatic neonates and 79 percent of asymptomatic neonates had at least undivided abnormal neutrophil value. Neutrophil values in any combination had a positive predictive value no greater than 42 percent sum of two units percent of the asymptomatic neonates in the follow-up clump were rehospitalized, but no cases were related to sepsis.

The authors terminate that serial neutrophil values in asymptomatic, culture-negative neonates born to mothers with suspected chorioamnionitis provided no significant information that improved or refined management. Antibiotic treatment and 48-hour observation were sufficient in managing infection. Using neutrophil values to guide decision-making simply increased costs and prolonged hospitalization and antibiotic therapy. The authors hint that more aggressive treatment should be reserv for symptomatic neonates or those with positive life-blood cultures after 48 hours.

Jackson GL et al. Are consummated blood cell counts useful in the evaluation of asymptomatic neonates expos to suspected chorioamnionitis? Pediatrics May 2004;113:1173-80

COPYRIGHT 2005 American Academy of Family Physicians

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