Does the Degree of Maternal Fever in the Setting of Chorioamnionitis Lead to Adverse Neonatal Outcomes?Funding None.
Objective The effect of the degree of maternal fever in the setting of chorioamnionitis on neonatal morbidity is unclear. The objective of this study is to assess the association between high maternal fevers (≥ 39°C) on neonatal morbidity.
Study Design Secondary analysis of Maternal-Fetal Medicine Units (MFMU) Cesarean Registry data obtained from 1999 to 2002 among singleton gestations with chorioamnionitis. Women with a temperature less than 39°C (low fever) compared with those with greater than or equal to 39°C (high fever). Primary outcome was a composite of adverse neonatal outcomes such as death, sepsis, necrotizing enterocolitis, grade-3 or -4 intraventricular hemorrhage, seizure within 24 hours of delivery, intubation within 24 hours of delivery, and requiring cardiopulmonary resuscitation. Demographic characteristics compared using Fisher's exact and Wilcoxon's rank-sum test as appropriate. Multivariate logistic regression analysis with performed to control for cofounders. Stratified analysis also performed to assess outcomes in term infants.
Results Of 1,313 included women, 1,200 (91.3%) were in the low fever group and 113 (8.7%) were in the high fever group. Women in the high fever group were more likely to be African American and group B Streptococcus positive. No difference in primary outcome was noted between the groups (38.9% high fever vs. 35.8% low fever, p = 0.54). High maternal fever was associated with increased risk of NICU admission (48.1 vs. 50.4%, p = 0.02). When controlling for African American race, preterm birth, and delivery route, patients with high fever were not more likely to have adverse neonatal outcomes (adjusted odds ratio [aOR] = 1.28, 95% confidence interval [CI]: 0.84, 1.98). In the analysis limited to term infants, when controlling for confounders, high fever, similarly, was not associated with increased odds of adverse neonatal outcomes (aOR = 1.59, 95% CI: 0.96, 2.65).
Conclusion The degree of maternal fever does not appear to be associated with an increased likelihood of adverse neonatal outcomes. Better understanding maternal factors that affect neonatal morbidity in the setting of chorioamnionitis is critical.
High maternal fever in the setting of chorioamnionitis does not appear to have an increased likelihood of adverse neonatal outcomes.
It is important to identify factors that may increase the risk of adverse outcomes such as early onset sepsis.
Maternal fever may not be a strong indicator for neonatal outcomes and antibiotic protocols.
Eingereicht: 29. Februar 2020
Angenommen: 08. Oktober 2021
Artikel online veröffentlicht:
04. Februar 2022
© 2022. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)
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- 1 Gibbs RS, Duff P. Progress in pathogenesis and management of clinical intraamniotic infection. Am J Obstet Gynecol 1991; 164 (5, pt. 1): 1317-1326
- 2 Goldenberg RL, Andrews WW, Hauth JC. Choriodecidual infection and preterm birth. Nutr Rev 2002; 60 (5, pt. 2): S19-S25
- 3 Eschenbach DA. Ureaplasma urealyticum and premature birth. Clin Infect Dis 1993; 17 (Suppl. 01) S100-S106
- 4 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; 196 (06) 524.e1-524.e5
- 5 Soper DE, Mayhall CG, Dalton HP. Risk factors for intraamniotic infection: a prospective epidemiologic study. Am J Obstet Gynecol 1989; 161 (03) 562-566 , discussion 566–568
- 6 Fahey JO. Clinical management of intra-amniotic infection and chorioamnionitis: a review of the literature. J Midwifery Womens Health 2008; 53 (03) 227-235
- 7 Newton ER, Piper J, Peairs W. Bacterial vaginosis and intraamniotic infection. Am J Obstet Gynecol 1997; 176 (03) 672-677
- 8 Yoon BH, Romero R, Moon JB. et al. Clinical significance of intra-amniotic inflammation in patients with preterm labor and intact membranes. Am J Obstet Gynecol 2001; 185 (05) 1130-1136
- 9 Gomez R, Romero R, Ghezzi F, Yoon BH, Mazor M, Berry SM. The fetal inflammatory response syndrome. Am J Obstet Gynecol 1998; 179 (01) 194-202
- 10 Gotsch F, Romero R, Kusanovic JP. et al. The fetal inflammatory response syndrome. Clin Obstet Gynecol 2007; 50 (03) 652-683
- 11 Newton ER. Chorioamnionitis and intra-amniotic infection. Clin Obstet Gynecol 1993; 36 (04) 795-808
- 12 Dashe JS, Rogers BB, McIntire DD, Leveno KJ. Epidural analgesia and intrapartum fever: placental findings. Obstet Gynecol 1999; 93 (03) 341-344
- 13 Committee on Obstetric P. Committee Opinion No. Committee opinion no. 712: intrapartum management of intra-amniotic infection. Obstet Gynecol 2017; 130 (02) e95-e101
- 14 Lieberman E, Lang J, Richardson DK, Frigoletto FD, Heffner LJ, Cohen A. Intrapartum maternal fever and neonatal outcome. Pediatrics 2000; 105 (1, pt. 1): 8-13
- 15 Landon MB, Leindecker S, Spong CY. et al; National Institute of Child Health and Human Development Maternal-Fetal Medicine Units Network. The MFMU Cesarean Registry: factors affecting the success of trial of labor after previous cesarean delivery. Am J Obstet Gynecol 2005; 193 (3, pt. 2): 1016-1023
- 16 Puopolo KM, Draper D, Wi S. et al. Estimating the probability of neonatal early-onset infection on the basis of maternal risk factors. Pediatrics 2011; 128 (05) e1155-e1163
- 17 Sahni M, Franco-Fuenmayor ME, Shattuck K. Management of late preterm and term neonates exposed to maternal chorioamnionitis. BMC Pediatr 2019; 19 (01) 282
- 18 Antibiotics for Early-Onset Neonatal Infection: Evidence Update June 2014: A Summary of Selected New Evidence Relevant to NICE Clinical Guideline 149 “Antibiotics for Early-Onset Neonatal Infection: Antibiotics for the Prevention and Treatment of Early-Onset Neonatal Infection” (2012). London, United Kingdom: National Institute for Health and Care Excellence; 2014
- 19 Higgins RD, Saade G, Polin RA. et al; Chorioamnionitis Workshop Participants. Evaluation and management of women and newborns with a maternal diagnosis of chorioamnionitis: summary of a workshop. Obstet Gynecol 2016; 127 (03) 426-436
- 20 Kuzniewicz MW, Puopolo KM, Fischer A. et al. A quantitative, risk-based approach to the management of neonatal early-onset sepsis. JAMA Pediatr 2017; 171 (04) 365-371
- 21 Goel N, Shrestha S, Smith R. et al. Screening for early onset neonatal sepsis: NICE guidance-based practice versus projected application of the Kaiser Permanente sepsis risk calculator in the UK population. Arch Dis Child Fetal Neonatal Ed 2020; 105 (02) 118-122
- 22 Towers CV, Yates A, Zite N, Smith C, Chernicky L, Howard B. Incidence of fever in labor and risk of neonatal sepsis. Am J Obstet Gynecol 2017; 216 (06) 596.e1-596.e5