Associatie tussen early onset neonatle sepsis en chorioamnionitis +/- funisitis.

IJkema, J. (Jelke) (2015) Associatie tussen early onset neonatle sepsis en chorioamnionitis +/- funisitis. thesis, Medicine.

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Abstract

Background: Early Onset Neonatal Sepsis (EONS) is a major cause of morbidity and mortality in premature infants <32 weeks. The clinical features are non-specific, the blood culture is often (false) negative and postpartum CRP of the newborn has a limited positive predictive value. Therefore, premature infants receive long-term treatment with antibiotics. However, antibiotic treatment has negative consequences for the premature: it affects the intestinal flora and increases the risk at NEC for instance. In addition, it contributes to resistance. Previous studies have shown a significant relationship between culture-proven EONS and histological inflammatory response in the placenta. But it has never been used in clinical practice. Aims: To determine the association between EONS and histological inflammatory response. In addition, the use of antibiotics will be studied. Furthermore, the additional value of histology in diagnosing EONS will be explored. Methods: In this retrospective association study, singletons <32 weeks, admitted to the NICU of the Isala Zwolle, from January 2013 to December 2013, are included. Collected data include: blood culture, surface cultures, CRP at day 0, 1 and 2, clinical features of sepsis, maternal risk factors and clinical manifestations of an intra-uterine infection. Furthermore, histological inflammatory response are analyzed in the placenta according to the Redline criteria. Children are divided into four groups: proven EONS, serial CRP≤10, CRP>10 with low suspicion of EONS and CRP>10 with high suspicion of EONS. Results: Data of 88 premature infants (240-316 weeks) are analyzed: 73 children with CRP≤10, 11 children with CRP>10 and low suspicion of EONS, and 4 children with CRP>10 and high suspicion of EONS. There is no proven EONS in this cohort. Histological inflammatory response is seen in 15/88 placenta’s (17%). A significant relationship is found between suspected EONS and histological inflammatory response in the placenta (p=0.027, Fisher Exact). In absence of maternal risk factors for EONS, no histological inflammatory response was seen, despite of an increased CRP level (>10mg/L). 75/88 (85%) children in our cohort are treated with antibiotics, 37/75 (49%) >48 hours. Based on histology, the duration of the antibiotic therapy may be limited to 48 hours instead of >5 days in 15/37 children (41%). Conclusions: There is a significant association between suspected EONS and histological inflammatory response in the placenta. Histological examination of the placenta at 48 hours can be of additional diagnostic value for EONS and can provide a clinically relevant reduction in the duration of antibiotics.

Item Type:	Thesis (Thesis)
Supervisor name:	Lingen, R.A. van
Supervisor name:	d’Haens, E.J. and Hemels, M.A.C. and Afdeling Neonatologie and Isala klinieken Zwolle
Faculty:	Medical Sciences
Date Deposited:	25 Jun 2020 10:51
Last Modified:	25 Jun 2020 10:51
URI:	https://umcg.studenttheses.ub.rug.nl/id/eprint/1231

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