498 - Fetal Inflammatory Response Syndrome (FIRS) stage in placental pathology is associated with antibiotic use but not culture positive early onset sepsis in newborn inafnts.

Publication Number: 3479.498

Michele Dobnikar, Cleveland Clinic Fairview, Cleveland, OH, United States; Amy Heerema-McKenney, Cleveland Clinic Children's, Cleveland, OH, United States; Jackson H. Schelzig, Cleveland Clinic Children's, Bay Village, OH, United States; HANY ALY, Cleveland Clinic Children's Hospital, Cleveland, OH, United States; Anirudha Das, Cleveland Clinic Children's, Lakewood, OH, United States

Background: Fetal Inflammatory Response Syndrome (FIRS) is a systemic inflammatory reaction of the fetus that occurs in response to intrauterine infection or inflammation. Placental pathology staging FIRS has been shown to be associated with increased incidence of neonatal morbidities like neonatal early onset sepsis, persistent pulmonary hypertension of the newborn, and mortality. Stage 0 was no inflammation, 1 means neutrophils in chorion and amnion, 2 means vasculitis and phlebitis of the umbilical vein, while stage 3 was severe Funisitis.

Objective: To determine if higher stages of FIRS on placental pathological examination of late preterm and term newborn infants is associated with increased rate of neonatal early onset sepsis and antibiotic usage.

Design/Methods: In a retrospective case-control study, late preterm and term newborn infants (34 weeks of gestation or more) were included, where the maternal placenta was examined for staging of FIRS. Infants were divided into two groups: group A (received antibiotics within the first five days of life) and group B (did not receive antibiotics). Median and interquartile range were used to present data, and the chi-square test was used for nominal variables, while the Kruskal-Wallis H test was used for continuous variables.

Results: A total of 552 infants were included in the study. 380 infants (68.9%) did not receive antibiotics while 172 did (31.2%). There was no significant difference in gestational age or cord pH (arterial or venous) between the groups. The group that received antibiotics had significantly lower APGAR scores at 1 and 5 minutes, a longer duration of rupture of membranes, a higher incidence of maternal clinical chorioamnionitis, and an increased need for respiratory support. The FIRS stage was significantly higher in the group that received antibiotics (p=0.03). The blood Culture positivity was very low, with one subject positive in the group that received antibiotics and two in the group that did not receive antibiotics.

Conclusion(s): On placental pathological examination in late preterm and term newborn infants, a higher stage of FIRS was associated with increased use of antibiotics but not of blood culture-positive early onset sepsis.

Figure 1
Demographic characteristics of infants who were started on antibiotics vs those who were not.