Risk Factor Evaluation in Term/Near-Term Neonates Born over 24 Hours After PROM

Hsiao-Neng Chen ； Yu-Jun Chang

《The Changhua Journal of Medicine》 16卷1期 (2018/03) Pp. 1-13

https://doi.org/10.6501/CJM.201803_16(1).0001

摘要

Background: Few studies have investigated the predictors of infection in term and near-term neonates delivered more than 24 hours after premature rupture of membranes (PROM) following the implementation of the Centers for Disease Control (CDC) and Prevention program for group B streptococcal (GBS) disease in 2002. Methods: This retrospective cohort study comprised neonates with birth weights ≥ 2,000 g at ≥ 34 weeks' gestation born to mothers more than 24 hours after PROM. Infection was diagnosed if neonates had a positive blood culture result and/or respiratory symptoms with radiographic evidence of pneumonia. Results: Of the 253 neonates included, 24 (9.5%) had radiographic evidence of pneumonia and one (0.40%) had a blood culture positive for GBS. Neonates with signs of respiratory distress had increased adjusted odds of early-onset infection (EOI). Infants born to mothers who did not receive antepartum antibiotics, and those with a band neutrophil count ＞ 2,000 cells/mm^3, an immature neutrophil to total neutrophil (I/T) ratio ≥ 0.3, and a granulocyte count ＜ 5,000 cells/mm^3 were at increased risk of EOI. Conclusion: Among PROM neonates, antibiotics are indicated for those who present with respiratory distress and/or a high post-natal immature neutrophil count, a high I/T ratio, a low white cell count, and those born to GBS-carrier mothers who did not receive intrapartum antibiotics.

關鍵字

CBC parameters ； neonatal infection ； premature rupture of membranes ； respiratory distress