411 - Prognostic factor for perinatal bacterial transmission from colonized mother to delivered VLBWI

Poster Number: 411
Publication Number: 411.334

Jieun Hwang, Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Gangnam-gu, Seoul-t'ukpyolsi, Republic of Korea; Sumin Kim, Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, seoul, Seoul-t'ukpyolsi, Republic of Korea; Misun Yang, Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Gangnam-gu, Seoul-t'ukpyolsi, Republic of Korea; Se In Sung, Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Gangnam-gu, Seoul-t'ukpyolsi, Republic of Korea; soyoon ahn, Samsung Medical Center, SEOUL, Seoul-t'ukpyolsi, Republic of Korea; yunsil chang, Department of Pediatrics, Samsung Medical Center Sungkyunkwan University School of Medicine, seoul, Seoul-t'ukpyolsi, Republic of Korea

Background: In light of the difficulties of treating very low birth weight infants (VLBWI), unnecessary broad-spectrum antibiotics is commonly used in these very preterm infants due to concern about perinatal bacterial transmission and following EoNS. Maternal vaginal colonization is one of the well- known risk factors for bacterial transmission. However, little has been known about the maternal and neonatal predictable factors for transmission of bacteria in VLBWI with maternal colonization. 

Objective: We tried to investigate prognostic factors of perinatal bacterial transmission in very low birth weight infants with maternal colonization or bacteremia history.

Design/Methods: We retrospectively reviewed the medical records at Samsung medical center (SMC) of 173 VLBWI with confirmed pathogen in maternal culture (vagina, urine, blood, cerclage knot) during whole intrapartum period from 2013 to 2020. Group 1, control group (n=128) was defined as infants born in colonized mother with no proven bacteria. Group 2, transmission group (n=45) was defined as having same pathogen with mother which is proven in blood culture, endotracheal culture in the first seven days of life, gastric aspirate culture and skin culture obtained right after birth of life. We compared perinatal maternal and neonatal characteristics and clinical outcomes between two groups with logistic regression. 

Results: In total 173, most common maternal colonized pathogen was Candida species (24.8%) and E.coli (24.1%). The main culture proven pathogen in neonates was E.coli(30.2%). In neonatal characteristics, group 2 presented significantly lower gestational age (GA), birth weight (BW), Apgar scores, and initial pH, base excess, and higher C-reactive protein (CRP), and higher incidence of use of surfactant and endotracheal intubation. In maternal characteristics, group 2 showed significantly higher incidence of pathologic chorioamnionitis and cervical cerclage, and had higher WBC count ( >15,000/ul) compared to group 1. In multivariable logistic regression analysis, group 2 displayed significantly higher odds ratio of initial CRP, pathologic chorioamnionitis, and cervical cerclage compared to group 1.

Conclusion(s): In this retrospective cohort study, higher neonatal initial CRP, pathologic chorioamnionitis, and history of cervical cerclage may be associated with perinatal bacterial transmission from mother to infant. These findings above might be useful when considering antibiotic treatment for infants with maternal colonization history right after birth and warrants further large-scale study.