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13 pages, 467 KiB

Open AccessArticle

Diagnostic Utility of Interleukin-6 in Early-Onset Sepsis among Term Newborns: Impact of Maternal Risk Factors and CRP Evaluation

by Maria Schleier, Julia Lubig, Sven Kehl, Steven Hébert, Joachim Woelfle, Adriana van der Donk, Alisa Bär, Heiko Reutter, Tobias Hepp and Patrick Morhart

Children 2024, 11(1), 53; https://doi.org/10.3390/children11010053 - 30 Dec 2023

Cited by 6 | Viewed by 2519

Abstract

(1) Background: Interleukin-6 (IL-6) levels act as an early infection marker preceding C-reactive protein (CRP) elevation. This study seeks to analyze IL-6 behavior in suspected early-onset sepsis (EOS) cases among term newborns, comparing it to that of CRP and evaluating IL-6’s diagnostic utility. We also aim to assess the impact of maternal risk factors on EOS in term newborns, quantifying their influence for informed decision making. (2) Methods: The retrospective data analysis included 533 term newborns who were admitted to our hospital because of suspected EOS. IL-6, CRP, and the impact of maternal risk factors were analyzed in the context of EOS using binomial test, Chi-squared test, logistic and linear regression. (3) Results: In the cases of EOS, both IL-6 and CRP were elevated. The increase in CRP can be predicted by the initial increase in IL-6 levels. Among the assessed risk factors, intrapartum maternal fever (adjusted odds ratio 18.1; 95% CI (1.7–4.1)) was identified as the only risk factor significantly associated with EOS. (4) Conclusions: Employing IL-6 as an early infection marker enhanced EOS diagnostic precision due to its detectable early rise. However, caution is required, as elevations in IL-6 and CRP levels do not exclusively indicate EOS. Increased CRP levels in healthy newborns with maternal risk factors may be attributed to dynamics of vaginal labor. Full article

(This article belongs to the Special Issue Advances in Healthcare for Neonates Volume II)

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8 pages, 682 KiB

Open AccessBrief Report

Intrapartum Maternal Fever and Long-Term Infectious Morbidity of the Offspring

by Omri Zamstein, Tamar Wainstock and Eyal Sheiner

J. Clin. Med. 2023, 12(9), 3329; https://doi.org/10.3390/jcm12093329 - 7 May 2023

Cited by 3 | Viewed by 2669

Abstract

Maternal intrapartum fever can lead to various maternal and neonatal complications and is attributed to various etiologies including infectious and non-infectious processes. In this study, we evaluated whether intrapartum fever affects the offspring’s tendency to long-term infectious morbidity. A population-based cohort analysis including deliveries between 1991 and 2021 was conducted. The incidence of hospitalizations of the offspring up to the age of 18 years, due to various infectious conditions, was compared between pregnancies complicated by intrapartum fever and those that were not. A Kaplan–Meier survival curve was used to assess cumulative hospitalization incidence. A Cox proportional hazards model was used to control for confounders. Overall, 538 of the 356,356 included pregnancies were complicated with fever. A higher rate of pediatric hospitalizations due to various infectious conditions was found among the exposed group, which was significant for viral, fungal and ENT infections (p < 0.05 for all). The total number of infectious-related hospitalizations was significantly higher (30.1% vs. 24.1%; OR = 1.36; p = 0.001), as was the cumulative incidence of hospitalizations. This association remained significant after controlling for confounders using a Cox proportional hazards model (adjusted HR = 1.21; 95% CI 1.04–1.41, p = 0.016). To conclude, fever diagnosed close to delivery may influence offspring susceptibility to pediatric infections. Full article

(This article belongs to the Section Obstetrics & Gynecology)

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8 pages, 490 KiB

Open AccessArticle

Risk Factors for Perineal Wound Breakdown in Early Postpartum: A Retrospective Case–Control Study

by Amandine Puissegur, Marie Accoceberry, Marion Rouzaire, Bruno Pereira, Marie Herault, Clément Bruhat, Amélie Delabaere and Denis Gallot

J. Clin. Med. 2023, 12(8), 3036; https://doi.org/10.3390/jcm12083036 - 21 Apr 2023

Cited by 4 | Viewed by 4775

Abstract

We conducted a retrospective case–control study in patients presenting a perineal tear (second degree or higher) or episiotomy complicated by wound breakdown during maternity stay to identify risk factors associated with wound breakdown in early postpartum with a view to improving the quality of care. We collected ante- and intrapartum characteristics and outcomes at the postpartum visit. In all, 84 cases and 249 control subjects were included. In univariate analysis, primiparity, absence of history of vaginal delivery, a longer second phase of labour, instrumental delivery, and a higher degree of laceration emerged as risk factors for early perineal suture breakdown postpartum. Gestational diabetes, peripartum fever, streptococcus B, and suture technique did not emerge as risk factors for perineal breakdown. Multivariate analysis confirmed that instrumental delivery (OR = 2.18 [1.07; 4.41], p = 0.03) and a longer second phase of labour (OR = 1.72 [1.23; 2.42], p = 0.001) were risk factors for early perineal suture breakdown. Full article

(This article belongs to the Section Obstetrics & Gynecology)

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8 pages, 448 KiB

Open AccessBrief Report

Impact of Thin Meconium on Delivery and Early Neonatal Outcomes

by Hanoch Schreiber, Adi Shilony, Reut Batia Amrami, Gal Cohen, Ofer Markovitch, Tal Biron-Shental, Sofia Bauer-Rusek, Shmuel Arnon and Michal Kovo

Children 2023, 10(2), 215; https://doi.org/10.3390/children10020215 - 26 Jan 2023

Cited by 1 | Viewed by 2758

Abstract

Several reports regarding the effects of thin meconium on maternal and neonatal outcomes are contradictory. This study evaluated the risk factors and obstetrical outcomes during deliveries complicated with thin meconium. This retrospective cohort study included all women with a singleton pregnancy, who underwent trial of labor >24 weeks of gestation, in a single tertiary center, over a six-year period. Obstetrical, delivery, and neonatal outcomes were compared between deliveries with thin meconium (thin meconium group) to deliveries with clear amniotic fluid (control group). Included in the study were 31,536 deliveries. Among them 1946 (6.2%) were in the thin meconium group and 29,590 (93.8%) were controls. Meconium aspiration syndrome was diagnosed in eight neonates in the thin meconium group and in none of the controls (0.41%, p < 0.001). In multivariate logistic regression analysis, the following adverse outcomes were found to be independently associated with increased odds ratio (OR) for thin meconium: intrapartum fever (OR 1.37, 95% CI 1.1–1.7), instrumental delivery (OR 1.26, 95% CI 1.09–1.46), cesarean delivery for non-reassuring fetal heart rate (OR 2.0, 95% CI 1.68–2.46), and respiratory distress requiring mechanical ventilation (OR 2.06, 95% CI 1.19–3.56). Thin meconium was associated with adverse obstetrical, delivery, and neonatal outcomes that should receive extra neonatal care and alert the pediatrician. Full article

(This article belongs to the Special Issue Complementary Feeding in Newborns)

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10 pages, 1949 KiB

Open AccessArticle

Relationship between Maternal Fever and Neonatal Sepsis: A Retrospective Study at a Medical Center

by Sheng-Hua Huang, Yu-Jun Chang, Lih-Ju Chen, Cheng-Han Lee, Hsiao-Neng Chen, Jia-Yuh Chen and Chien-Chou Hsiao

Biomedicines 2022, 10(9), 2222; https://doi.org/10.3390/biomedicines10092222 - 7 Sep 2022

Cited by 5 | Viewed by 2403

Abstract

Various risk factors are associated with neonatal sepsis; however, its relationship to maternal postpartum fever is unknown. This study aimed to determine the relationship between maternal postpartum fever and neonatal sepsis. Full-term and late preterm stable infants born from January 2019 to June 2021 and whose mothers developed intra- or post-partum fever were included in the study. After the newborns were transferred to the nursery, laboratory assessments were performed. Based on clinical conditions and data, the newborns were divided into unlikely sepsis and probable/proven sepsis groups. Maternal fever onset, duration, and maximum body temperature were recorded. We included 1059 newborns whose mothers developed fever intra-partum (n = 192), post-partum (n = 844), and intra- and post-partum (n = 23). The newborns were grouped into those with unlikely sepsis (n = 550) and those with probable/proven sepsis (n = 509). The incidence of intrapartum fever was higher in the probable/proven sepsis group than in the unlikely sepsis group (27.9% vs. 13.3%, p < 0.001). The incidence of postpartum fever was lower in the probable/proven sepsis group than in the unlikely sepsis group (74.7% vs. 88.5%, p < 0.001). Development of maternal fever within 1.8 h postpartum and a newborn respiratory rate of >60 breaths/min were positive predictors (91.6%) for neonatal probable/proven sepsis. Full article

(This article belongs to the Section Microbiology in Human Health and Disease)

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17 pages, 263 KiB

Open AccessReview

Antibiotic Use and Misuse during Pregnancy and Delivery: Benefits and Risks

by Begoña Martinez De Tejada

Int. J. Environ. Res. Public Health 2014, 11(8), 7993-8009; https://doi.org/10.3390/ijerph110807993 - 7 Aug 2014

Cited by 102 | Viewed by 13161

Abstract

Although pregnancy is considered as a physiological state, most pregnant women in developed countries receive multiple medications to prevent maternal or neonatal complications, with antibiotics among the most frequently prescribed. During pregnancy, antibiotics are often prescribed in the context of preterm labor, intrapartum fever, prevention of neonatal Group B Streptococcus fever, and cesarean section. Outside this period, they are commonly prescribed in the community setting for respiratory, urinary, and ear, nose and throat infection symptoms. Whereas some of the current indications have insightful reasons to justify their use, potential risks related to overuse and misuse may surpass the benefits. Of note, the recent 2014 World Health Assembly expressed serious concern regarding antibiotic resistance due to antibiotic overuse and misuse and urged immediate action to combat antibiotic resistance on a global scale. Most studies in the obstetrics field have focused on the benefits of antibiotics for short-term maternal and neonatal complications, but with very little (if any) interest in long-term consequences. Full article

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