LAUSR

For neonatologists, decisions about how to manage well-appearing newborns with risk factors for sepsis remain fraught. Maternal chorioamnionitis (inflammation of the chorion and amnion) caused by intrauterine bacterial infection affects 0.1% to 2% of pregnancies1,2 and increases the newborn’s risk of early-onset sepsis.1,3 For this reason, clinical guidelines published by the Centers for Disease Control and Prevention in 20104 and the American Academy of Pediatrics in 2012 (with a subsequent clarifying supplement in 2013)5,6 recommended that all well-appearing term newborns whose mothers were diagnosed with chorioamnionitis undergo laboratory screening for sepsis, including blood culture, and receive at least 48 hours of broad-spectrum antibiotic therapy. However, consensus has shifted in the years since these recommendations were published. Multiple studies and commentaries have suggested that performing sepsis evaluations on all well-appearing term newborns with a maternal history of chorioamnionitis is unnecessary and may have significant downsides, including: interference with breastfeeding and bonding; alteration of the neonatal microbiome (with uncertain long-term consequences); and risk of … Address correspondence to Richard A. Polin, MD, NewYork-Presbyterian Morgan Stanley Children’s Hospital, 3959 Broadway, CHC102, New York, NY 10032. E-mail: rap32{at}cumc.columbia.edu