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hiserrud

Chorioamnionitis

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I am interested in management of well term infants who fall into the algorithm for Chorio treatment with 48 hours of abx pending negative cultures. I work in a Level I nursery and we have been contemplating 24 hours in the nursery on the monitor then out to the Mom's room saline locked   getting their last day of meds in the Mom's room. does anyone have a protocol.

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In Kwa Zulu Natal South Africa we are advocating that well at risk term babies are monitored (and if necessary receive antibiotics via short line-hep locked)  in skin to skin care with their mother in post natal and are only admitted to the neonatal unit if they develop problems.

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Our protocol was to treat every newborn born with maternal diagnosis of chorioamnionitis (at least 48 hours of antibiotics, longer if suspicion for sepsis gets stronger). The confirmed cases of sepsis were very rare occurrence. Diagnosis of chorioamnionitis is also a problem (many times just on basis of maternal temperature). Starting this year, we are participating in collaborative QI project of Vermont-Oxford Network (year-long project) and have started to use the sepsis risk calculator to have an evidence based approach to evaluation and management of babies for early onset sepsis/maternal chorioamnionitis. You may want to look into use of this calculator in your settings. References: Pediatrics2014;133:30-36

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1) Our institutional practice (High volume, high acuity delivery service, 12k births/year) is to have a 'Chorio' nursery monitored and staffed by NICU RN and, covered by a pediatric hospitalist.  Babies are admitted there for culture, antibiotics and screening CBC and CRP.  Post-partum mothers are roomed on the same floor so they can more easily see their baby and feed.  Assuming child is clinically well, antibiotics are stopped at 24-36h depending on biomarkers and the baby is transferred to the mother's room for remainder of stay.  

2) We are studying the use of the Kaiser calculator, but there is lots of hesitancy about sending these babies directly to the normal nursery service as there is the perception (right or wrong) that a clinical decompensation in a baby would not be noticed by the normal nursery nurses in a timely manner.  The other thing which is relevant for members of this forum is to understand that the Kaiser calculator is based on Likelihood ratios and knowledge of the background rate of neonatal sepsis in the population in question.  While the calculator allows you to select a range of baseline risks, it is tuned (roughly) based on the US CDC baseline risk of 0.5/1000.  If your local epidemiology is very different from the kaiser assumptions, the recommendations from the calculator may be wrong (disastrously so).

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