Comparison of proposed National Institute of Child Health and Human Development panel recommendations with newborn sepsis risk calculator in term neonates exposed to maternal chorioamnionitis

BACKGROUND

Maternal chorioamnionitis (MC) is one of the major risk factors for early-onset neonatal sepsis. Kaiser sepsis risk calculator (SRC) is a validated risk assessment tool for such newborns. The National Institute of Child Health and Human Development (NICHD) workshop on MC has proposed a risk assessment algorithm. The objective of the study was to compare the reduction in antibiotic use in newborns treated with SRC and NICHD algorithm and determine the antibiotic use correlation between them.

METHODOLOGY

A retrospective chart review was performed on newborns born at ≥ 37 weeks to mothers with MC during the years 2018-2020. The same cohort of newborns was evaluated using SRC and NICHD algorithm to determine whether treatment with antibiotics could have been avoided in some patients. The data were analyzed using a t-test, Chi-square test, and ANOVA.

RESULTS

During the study period, 101 newborns were born to mothers with chorioamnionitis and received antibiotics. When the newborns were assessed using the SRC, only 16/101 (15.84%) would have received treatment. When NICHD algorithm was applied to the same cohort 71/101 (70.30%) newborns would have received treatment. The two approaches agreed in their assessment for treatment or observation only in 44/101 (43.56%) of the cases. The NICHD treatment group had a higher incidence of chorioamnionitis as seen in placental pathology (94.37% vs. 75.00% for Kaiser, p-0.015). The SRC treatment group however had newborns with significantly lower Apgar score at 1 min (8.21 vs 6.63, p-0.006) and 5-minute (8.69 vs 8.00, p-0.019) and had significantly higher supplemental oxygen requirements at admission (62.50% vs. 21.13%, p < 0.001).

CONCLUSION

Both SRC and NICHD algorithms expose fewer newborns to antibiotics; however, they differ in the number of newborns that would require antibiotics. Ventilation assistance and lower Apgar scores were associated with higher probability of antibiotic administration.

A variable presentation of Joubert syndrome: Case report and a brief review

Joubert syndrome is a rare neurological manifestation usually present in late infancy or early childhood with characteristic episodes of abnormal breathing pattern along with the neurological and other systemic involvement.We report a case of confirmed Joubert syndrome present in the immediate neonatal period with isolated spells of oxygen desaturations not accompanied by the classically described breathing pattern and absent neurological symptoms causing delay in the diagnosis. Isolated oxygen desaturation episodes could be a presenting manifestation of Joubert syndrome in a neonatal period.

In Utero Vertical Transmission of Coronavirus Disease 2019 in a Severely Ill 29-week Preterm Infant

Severe acute respiratory syndrome coronavirus 2 (SARS-Cov-2) or coronavirus disease 2019 (COVID-19) is currently in worldwide pandemic state with very limited data about the mode of transmission to the growing fetus. There are a few published cases of COVID-19 infection in the infants born to COVID-19 positive mothers where most of the reported cases were either mildly symptomatic with positive COVID-19 polymerase chain reaction (PCR) or had negative COVID-19 PCR raising the question of vertical transmission. We present a case of likely intrauterine transmission of COVID-19 infection in a critically ill premature infant born to a COVID-19 infected mother and describing her clinical course thus far. The clinical presentation in the infant is consistent with COVID-19 infection described so far in literature along with positive PCR, and positive COVID-19 serology: immunoglobulin G, immunoglobulin M, and immunoglobulin A.