Choriophobia: a 1-act play

Pediatrics. 2012 Aug;130(2):342-6. doi: 10.1542/peds.2012-0106. Epub 2012 Jul 9.

Abstract

The management of a newborn born to a mother with chorioamnionitis is controversial. By using data collected on neonates born in the era of routine maternal screening for Group B Streptococcus, we calculate that the risk of early-onset sepsis in a hypothetical infant born at term to a mother with chorioamnionitis, who has a normal physical examination at birth, is likely substantially <1% if the mother's screen for Group B Streptococcus was negative. This low rate of sepsis calls into question current guidelines recommending treatment of all such newborns with intravenous antibiotics for 48 hours pending the results of a blood culture. Current guidelines for the management of infants born to mothers with chorioamnionitis also raise an important ethical issue; the recommendation to treat these infants with intravenous antibiotics is, in essence, a de facto determination of what constitutes unacceptable risk to the newborn. We argue that this determination is ultimately value-based and therefore requires broader deliberation than that which frequently occurs among medical experts who develop medical guidelines.

MeSH terms

  • Academic Medical Centers
  • Adult
  • Anti-Bacterial Agents / therapeutic use
  • Chorioamnionitis / diagnosis*
  • Chorioamnionitis / drug therapy*
  • Cooperative Behavior
  • Ethics, Medical
  • Female
  • Guideline Adherence / ethics
  • Humans
  • Infant, Newborn
  • Infusions, Intravenous / ethics
  • Interdisciplinary Communication
  • Internship and Residency
  • Medical Staff, Hospital
  • Pregnancy
  • Sepsis / diagnosis
  • Sepsis / drug therapy
  • Streptococcal Infections / diagnosis*
  • Streptococcal Infections / drug therapy*
  • Streptococcus agalactiae*
  • Unnecessary Procedures / ethics

Substances

  • Anti-Bacterial Agents