This Article
Right arrow Full Text
Right arrow Full Text (PDF)
Right arrow P3Rs: Submit a response
Right arrow P3Rs: View responses
Right arrow Alert me when this article is cited
Right arrow Alert me when P3Rs are posted
Right arrow Alert me if a correction is posted
Right arrow Citation Map
Services
Right arrow E-mail this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in ISI Web of Science
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to My File Cabinet
Right arrow Download to citation manager
Right arrow reprints & permissions
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via CrossRef
Right arrow Citing Articles via ISI Web of Science (2)
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Jackson, G. L.
Right arrow Articles by Rosenfeld, C. R.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Jackson, G. L.
Right arrow Articles by Rosenfeld, C. R.
Related Collections
Right arrow Infectious Disease & Immunity
PEDIATRICS Vol. 113 No. 5 May 2004, pp. 1173-1180

Are Complete Blood Cell Counts Useful in the Evaluation of Asymptomatic Neonates Exposed to Suspected Chorioamnionitis?

Gregory L. Jackson, MD, MBA*, William D. Engle, MD*, Dorothy M. Sendelbach, MD*, Debra A. Vedro, PNP{ddagger}, Sue Josey, PNP{ddagger}, Jodi Vinson, PNP{ddagger}, Carol Bryant, PNP{ddagger}, Gary Hahn, PNP{ddagger} and Charles R. Rosenfeld, MD*

* Department of Pediatrics, Division of Neonatal-Perinatal Medicine, University of Texas Southwestern Medical Center at Dallas, Dallas, Texas
{ddagger} Parkland Health and Hospital System, Dallas, Texas

Objective. Chorioamnionitis complicates 1% to 10% of pregnancies and increases the risk of neonatal infection. Women with chorioamnionitis receive intrapartum antibiotics, often resulting in inconclusive neonatal blood cultures. Peripheral neutrophil values are used frequently to assist in the diagnosis of neonatal infection and to determine duration of antibiotics; we sought to determine the utility of this approach.

Methods. A prospective observational study was performed in 856 near-term/term neonates who were exposed to suspected chorioamnionitis. Each received antibiotics for 48 hours unless clinical infection or positive blood cultures occurred. Peripheral neutrophils were measured serially and analyzed using the reference ranges of Manroe et al; an additional analysis of only the initial neutrophil values used the normal ranges of Schelonka et al. Results of neutrophil analyses were not used to determine duration of therapy. Fifty percent of asymptomatic neonates were seen postdischarge to ascertain recurrent infection. Local patient charges were examined.

Results. Ninety-six percent of neonates were asymptomatic and had negative cultures, and antibiotics were discontinued at 48 hours. A total of 2427 neutrophil counts were analyzed. Although abnormal neutrophil values were more frequent in infected or symptomatic neonates, 99% of asymptomatic neonates had ≥1 abnormal value. The specificity and negative predictive values for abnormal neutrophil values ranged between 0.12 and 0.95 and 0.91 and 0.97, respectively; sensitivity was 0.27 to 0.76. Significant differences in interpretation of the initial neutrophil values were noted, depending on the normal values used. Follow-up was performed for 373 asymptomatic neonates until 3 weeks’ postnatal age. Eight required rehospitalization; none had evidence of bacterial infection. If neutrophil values had been used to determine duration of antibiotics, then local costs would have increased by $76 000 to $425 000 per year.

Conclusions. Single or serial neutrophil values do not assist in the diagnosis of early-onset infection or determination of duration of antibiotic therapy in asymptomatic, culture-negative neonates who are ≥35 weeks’ gestation and are delivered of women with suspected chorioamnionitis.

Key Words: intraamniotic infection • neutrophil values • complete blood count • early-onset infection • antibiotic therapy • length of stay • resource utilization

Abbreviations: CDC, Centers for Disease Control and Prevention • CBC, complete blood cell count • ATN, absolute total neutrophil count • ATI, immature neutrophil count • I:T, immature neutrophil count:absolute total neutrophil count proportion • NBN, normal newborn nursery • GBS, group B streptococcus

Received for publication Jun 19, 2003; Accepted Jan 5, 2004.




This article has been cited by other articles:


Home page
 NeoReviewsHome page
P. F. Tumbaga and A. G.S. Philip
Perinatal Group B Streptococcal Infections and the New Guidelines: An Update
NeoReviews, October 1, 2006; 7(10): e524 - e530.
[Full Text] [PDF]

Home page
 JWatch GeneralHome page
CBCs, Neonates, and Chorioamnionitis
Journal Watch (General), June 1, 2004; 2004(601): 4 - 4.
[Full Text]

P3Rs:

Read all P3Rs

Labor and stress at delivery are confounders in the evaluation of neonatal sepsis
Eleanor J Molloy, et al.
Pediatrics Online, 28 May 2004 [Full text]