Incidence of early-onset sepsis in infants born to women with clinical chorioamnionitis
Tara M. Randis,Tara M. Randis,Madeline Murguia Rice,Leslie Myatt,Alan T.N. Tita,Kenneth J. Leveno,Uma M. Reddy,Michael W. Varner,John M. Thorp,Brian M. Mercer,Mara J. Dinsmoor,Susan M. Ramin,Marshall W. Carpenter,Philip Samuels,Anthony Sciscione,Jorge E. Tolosa,George R. Saade,Yoram Sorokin +17 more
TLDR
Clinical chorioamnionitis is common and is associated with neonatal morbidities, however, the vast majority of exposed infants (99.3%) do not have confirmed early-onset sepsis.Abstract:
Objective To determine the frequency of sepsis and other adverse neonatal outcomes in women with a clinical diagnosis of chorioamnionitis. Methods We performed a secondary analysis of a multi-center placebo-controlled trial of vitamins C/E to prevent preeclampsia in low risk nulliparous women. Clinical chorioamnionitis was defined as either the "clinical diagnosis" of chorioamnionitis or antibiotic administration during labor because of an elevated temperature or uterine tenderness in the absence of another cause. Early-onset neonatal sepsis was categorized as "suspected" or "confirmed" based on a clinical diagnosis with negative or positive blood, urine or cerebral spinal fluid cultures, respectively, within 72 h of birth. Adjusted odds ratios (ORs) and 95% confidence intervals (CIs) were estimated by logistic regression. Results Data from 9391 mother-infant pairs were analyzed. The frequency of chorioamnionitis was 10.3%. Overall, 6.6% of the neonates were diagnosed with confirmed (0.2%) or suspected (6.4%) early-onset sepsis. Only 0.7% of infants born in the setting of chorioamnionitis had culture-proven early-onset sepsis versus 0.1% if chorioamnionitis was not present. Clinical chorioamnionitis was associated with both suspected [OR 4.01 (3.16-5.08)] and confirmed [OR 4.93 (1.65-14.74)] early-onset neonatal sepsis, a need for resuscitation within the first 30 min after birth [OR 2.10 (1.70-2.61)], respiratory distress [OR 3.14 (2.16-4.56)], 1 min Apgar score of ≤3 [OR 2.69 (2.01-3.60)] and 4-7 [OR 1.71 (1.43-2.04)] and 5 min Apgar score of 4-7 [OR 1.67 (1.17-2.37)] (vs. 8-10). Conclusion Clinical chorioamnionitis is common and is associated with neonatal morbidities. However, the vast majority of exposed infants (99.3%) do not have confirmed early-onset sepsis.read more
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Evidence that intra-amniotic infections are often the result of an ascending invasion - a molecular microbiological study.
Roberto Romero,Nardhy Gomez-Lopez,Andrew D. Winters,Andrew D. Winters,Eun Jung Jung,Eun Jung Jung,Majid Shaman,Majid Shaman,Janine Bieda,Janine Bieda,Bogdan Panaitescu,Bogdan Panaitescu,Percy Pacora,Percy Pacora,Offer Erez,Offer Erez,Offer Erez,Jonathan M. Greenberg,Madison M. Ahmad,Chaur-Dong Hsu,Kevin R. Theis,Kevin R. Theis +21 more
TL;DR: Findings indicate that ascension from the lower genital tract is the primary pathway for intra-amniotic infection.
Journal ArticleDOI
Clinical chorioamnionitis at term IX: in vivo evidence of intra-amniotic inflammasome activation.
Nardhy Gomez-Lopez,Roberto Romero,Ely Maymon,Ely Maymon,Juan Pedro Kusanovic,Juan Pedro Kusanovic,Bogdan Panaitescu,Bogdan Panaitescu,Derek Miller,Derek Miller,Percy Pacora,Percy Pacora,Adi L. Tarca,Adi L. Tarca,Kenichiro Motomura,Kenichiro Motomura,Offer Erez,Offer Erez,Eun Jung Jung,Eun Jung Jung,Sonia S. Hassan,Sonia S. Hassan,Chaur-Dong Hsu +22 more
TL;DR: The intra-amniotic inflammatory response, either induced by alarmins or microbes, is characterized by the activation of the inflammasome – as evidenced by elevated amniotic fluid concentrations of extracellular ASC – in women with clinical chorioamnionitis at term.
Journal ArticleDOI
The origin of amniotic fluid monocytes/macrophages in women with intra-amniotic inflammation or infection
Nardhy Gomez-Lopez,Nardhy Gomez-Lopez,Roberto Romero,Yaozhu Leng,Yaozhu Leng,Yi Xu,Yi Xu,Rebecca Slutsky,Dustyn Levenson,Dustyn Levenson,Percy Pacora,Percy Pacora,Eun Jung Jung,Eun Jung Jung,Bogdan Panaitescu,Chaur-Dong Hsu,Chaur-Dong Hsu +16 more
TL;DR: Amniotic fluid monocytes/macrophages can be of either fetal or maternal origin, or a mixture of both, in women with intra-amniotic inflammation or infection and could be derived from the fetal and maternal vasculature of the placenta.
Journal ArticleDOI
Microbial burden and inflammasome activation in amniotic fluid of patients with preterm prelabor rupture of membranes.
Kevin R. Theis,Kevin R. Theis,Roberto Romero,Kenichiro Motomura,Kenichiro Motomura,Jose Galaz,Jose Galaz,Jose Galaz,Andrew D. Winters,Andrew D. Winters,Percy Pacora,Percy Pacora,Derek Miller,Derek Miller,Rebecca Slutsky,Violetta Florova,Violetta Florova,Dustyn Levenson,Dustyn Levenson,Robert Para,Robert Para,Aneesha Varrey,Aneesha Varrey,Marian Kacerovsky,Marian Kacerovsky,Chaur-Dong Hsu,Chaur-Dong Hsu,Nardhy Gomez-Lopez,Nardhy Gomez-Lopez +28 more
TL;DR: In this paper, the presence of microorganisms in amniotic fluid was investigated in women with preterm prelabor rupture of membranes (preterm PROM) in the presence/absence of detectable microorganisms and whether intra-amniotic inflammasome activation correlates with microbial burden.
Journal ArticleDOI
RNA Sequencing Reveals Diverse Functions of Amniotic Fluid Neutrophils and Monocytes/Macrophages in Intra-Amniotic Infection.
Nardhy Gomez-Lopez,Roberto Romero,Aneesha Varrey,Aneesha Varrey,Yaozhu Leng,Yaozhu Leng,Derek Miller,Derek Miller,Bogdan Done,Bogdan Done,Yi Xu,Yi Xu,Gaurav Bhatti,Gaurav Bhatti,Kenichiro Motomura,Kenichiro Motomura,Meyer Gershater,Meyer Gershater,Roger Pique-Regi,Roger Pique-Regi,Adi L. Tarca,Adi L. Tarca,Adi L. Tarca +22 more
TL;DR: The underlying complexity of local innate immune responses in women with intra-amniotic infection is demonstrated and new insights are provided into the functions of neutrophils and monocytes/macrophages in the amniotic cavity.
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