A lot of work has gone into the development of clinical practice guidelines for treatment of mothers and their newborns with suspected maternal chorioamnionitis. Yet in this era of antibiotic resistance, there are a lot of late preterm or term infants (>= 35 weeks’ gestation) whose mothers were managed according to these guidelines who look completely non-toxic and asymptomatic. Yet by receiving antibiotics, this approach to management may be separating unnecessarily baby from mother when breastfeeding is getting started, or even shift the microbiome of these babies in an unfavorable way if antimicrobials are not really warranted. So should these infants be treated with immediate empiric use of antibiotics for 48 hours? Jan et al. (10.1542/peds.2016-2744) attempt to answer that question by providing results from a retrospective data review over 6 years of asymptomatic infants whose mothers were diagnosed with chorioamnionitis and received blood cultures and C-reactive protein but no antibiotics if the baby looked well and the labs were unremarkable. The results show that at least two-thirds of the 240 initially asymptomatic infants did not receive antibiotics in this study and only those babies who looked sick or had worrisome lab values resulted in their use. There were a small number of babies who looked great and whose blood cultures did become positive.
Would these babies have cleared their infections without antibiotics? What do the results of this interesting study mean for future management of healthy looking infants born to mothers with chorioamnionitis? To help make sense of the findings in this study that could change how we manage asymptomatic late preterm or term newborns in the setting of maternal chorioamnionitis, we asked neonatologists Dr. Thomas Hooven and Richard Polin (10.1542/peds.2017-1155) to provide their input in an accompanying editorial well worth your attention. It’s a study like this one that can modify our existing guidelines on treatment or non-treatment of asymptomatic infants in the setting of chorioamnionitis. Read both the study and commentary and see what we mean.