A REVIEW ON PPROM (PRETERM PRELABOUR RUPTURE OF MEMBRANES) AND EARLY ONSET NEONATAL SEPSIS AND ROLE OF INFLAMMATORY MARKERS IN DIAGNOSIS OF MATERNAL AND NEONATAL INFECTION

  • MANASVI BOMMAREDDY Department of Obstetrics and Gynaecology, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India 576104
  • SHRIPAD HEBBAR Department of Obstetrics and Gynaecology, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India 576104

Abstract

One of the major problems in obstetrics and neonatology till today is occurrence of preterm births in spite of best possible antenatal care. Many preterm labour are due to PPROM (Prelabour Preterm Rupture Of Membranes) where infection plays a major role. The neonatal morbidity and mortality is directly related to maternal infection and early onset neonatal sepsis.Laboratory evaluation of various inflammatory markers such as TLC (total leucocyte count), ESR (Erythrocyte Sedimentation Rate), CRP (C- Reactive Protein) predict events such as maternal chorioamnionitis, neonatal sepsis with reasonable accuracy and hence are valuable tools in high dependency obstetric (HDU) and neonatal intensive care units (NICU). The following treatise mainly focusses on aetiopathogenenis, clinical features, haematological and biochemical parameters of maternal PPROM and neonatal sepsis. Understanding these factors, will definitely prevent adverse maternal outcomes such as postpartum infections and puerperal sepsis and perinatal events such as stillbirth due to intrauterine foetal infection, preterm birth, neonatal sepsis, long term sequele of chronic lung disease and brain injury leading to cerebral palsy and other neurodevelopmental disabilities.

Keywords: PPROM, EONI, Chorioamnionitis, C Reactive Protein, Neonatal sepsis

References

1. Romero, R, Athayde, N, Maymon, E, Pacora, P, and Bahado-Singh, R. Premature rupture of the membranes. in: Reece A, Hobbins J (Eds.) Medicine of the fetus and mother. Lippincott- Raven,Philadelphia; 1999: 1581–625.
2. Buck C, Bundschu J, Gallati H, Bartmann P, Pohlandt F. Interleukin-6: a sensitive parameter for the early diagnosis of neonatal bacterial infection. Pediatrics 1994;93(1):54-8.
3. Black RE, Cousens S, Johnson HL, et al. Global, regional, and national causes of child mortality in 2008: a systematic analysis. Lancet 2010;375(9730):1969-87.
4. Mahmood A, Fazal ur rehman, Chughtai F. A survey of infection control practices in the delivery room and nursery to investigate and control the high rate of neonatal sepsis: an experience at a secondary care hospital. J Pak Med Assoc 2008;58(5):237-40.
5. ACOG Practice Bulletin No. 80: premature rupture of membranes. Clinical management guidelines for obstetrician-gynecologists. Obstet Gynecol 2007;109(4):1007-19.
6. Mercer BM. Preterm premature rupture of the membranes: current approaches to evaluation and management. Obstet Gynecol Clin North Am 2005;32(3):411-28.
7. Kanayama N, Terao T, Kawashima Y, Horiuchi K, Fujimoto D. Collagen types in normal and prematurely ruptured amniotic membranes. Am J Obstet Gynecol 1985;153(8):899-903.
8. Naeye RL, Peters EC. Causes and consequences of premature rupture of fetal membranes. Lancet 1980;1(8161):192-4.
9. Gaucherand P, Salle B, Sergeant P, et al. Comparative study of three vaginal markers of the premature rupture of membranes. sulin like growth factor binding protein 1 diamine-oxidase pH. Acta Obstet Gynecol Scand 1997;76(6):536-40.
10. Rosemond RL, Lombardi SJ, Boehm FH. Ferning of amniotic fluid contaminated with blood. Obstet Gynecol 1990;75(3 Pt 1):338-40.
11. Muhammad NA, Muhammad ZH, Muhammad WA, Rabia S, Farooq A. Early Onset Neonatal Sepsis In Preterm Premature Rupture Of Membranes. Pakistan Armed Forces Medical Journal 2015; 65(2): 226-30.
12. ACOG Practice Bulletin No. 172: Premature Rupture of Membranes. Obstet Gynecol 2016;128(4):e165-77.
13. Jaiswal A, Hariharan C, Dewani D. Study of maternal and fetal outcomes in premature rupture of membrane in central rural India. International Journal of Reproduction, Contraception, Obstetrics and Gynecology 2017;6(4): 1409-12.
14. Baley JE, Goldfark J. Neonatal infections. In Klaus MH, Fanaroff AA, eds. Care of the High-risk Neonate. 5 'hed. Philadelphia NB Saunders Co 2001; 363-392.
15. Schuchat A. Neonatal group B streptococcal disease--screening and prevention. N Engl J Med 2000;343(3):209-10.
16. Hornik CP, Fort P, Clark RH, et al. Early and late onset sepsis in very-low-birth-weight infants from a large group of neonatal intensive care units. Early Hum Dev 2012;88 Suppl 2:S69-74.
17. Weston EJ, Pondo T, Lewis MM, et al. The burden of invasive early-onset neonatal sepsis in the United States, 2005-2008. Pediatr Infect Dis J 2011;30(11):937-41.
18. Polin RA, St geme JW. Neonatal sepsis. Adv Pediatr Infect Dis 1992;7:25-61.
19. Polin RA. Management of neonates with suspected or proven early-onset bacterial sepsis. Pediatrics 2012;129(5):1006-15.
20. Baker CJ, Kasper DL. Correlation of maternal antibody deficiency with susceptibility to neonatal group B streptococcal infection. N Engl J Med 1976;294(14):753-6.
21. Benitz WE, Gould JB, Druzin ML. Risk factors for early-onset group B streptococcal sepsis: estimation of odds ratios by critical literature review. Pediatrics 1999;103(6):e77.
22. Stoll BJ, Gordon T, Korones SB, et al. Late-onset sepsis in very low birth weight neonates: a report from the National Institute of Child Health and Human Development Neonatal Research Network. J Pediatr 1996;129(1):63-71.
23. Hood M, Janney A, Dameron G. Beta hemolytic streptococcus group B associated with problems of the perinatal period. Am J Obstet Gynecol 1961;82:809-18.
24. Phares CR, Lynfield R, Farley MM, et al. Epidemiology of invasive group B streptococcal disease in the United States, 1999-2005. JAMA 2008;299(17):2056-65.
25. Klinger G, Levy I, Sirota L, et al. Epidemiology and risk factors for early onset sepsis among very-low-birthweight infants. Am J Obstet Gynecol 2009;201(1):38.e1-6.
26. Tebruegge M, Curtis N. Enterovirus infections in neonates. Semin Fetal Neonatal Med 2009;14(4):222-7.
27. Stoll BJ, Hansen N, Fanaroff AA, et al. Changes in pathogens causing early-onset sepsis in very-low-birth-weight infants. N Engl J Med 2002;347(4):240-7.
28. Benjamin DK, Stoll BJ, Fanaroff AA, et al. Neonatal candidiasis among extremely low birth weight infants: risk factors, mortality rates, and neurodevelopmental outcomes at 18 to 22 months. Pediatrics 2006;117(1):84-92.
29. Lim WH, Lien R, Huang YC, et al. Prevalence and pathogen distribution of neonatal sepsis among very-low-birth-weight infants. Pediatr Neonatol 2012;53(4):228-34.
30. Verani JR, Mcgee L, Schrag SJ. Prevention of perinatal group B streptococcal disease--revised guidelines from CDC, 2010. MMWR Recomm Rep 2010;59(RR-10):1-36.
31. Wang K, Bhandari V, Chepustanova S, et al. Which biomarkers reveal neonatal sepsis?. PLoS ONE 2013;8(12):e82700.
32. Hornik CP, Benjamin DK, Becker KC, et al. Use of the complete blood cell count in early-onset neonatal sepsis. Pediatr Infect Dis J 2012;31(8):799-802.
33. Champa P, Shyam LK, Rajni K, Arvind S. Correlation of neonatal and maternal clinico-hematological parameters as predictors of early onset neonatal sepsis. International Journal of Contemporary Pediatrics 2017: 4(1): 36-42.
34. Mayuga WA, Isleta PF. Clinical correlation of neonatal and maternal haematological parameters as predictors of neonatal sepsis. PIDSP 2005; 9: 36–42.
35. Khair KB, Rahman MA, Sultana T, Roy CK, Rahman MQ, Shahidullah M, et al. Role of hematologic scoring system in early diagnosis of neonatal septicemia. BSMMU J 2010;3:62-7.
36. Manroe BL, Weinberg AG, Rosenfeld CR, Browne R. The neonatal blood count in health and disease. I. Reference values for neutrophilic cells. J Pediatr 1979;95(1):89-98.
37. Lambert RM, Baer VL, Wiedmeier SE, Henry E, Burnett J, Christensen RD. Isolated elevated blood neutrophil concentration at altitude does not require NICU admission if appropriate reference ranges are used. J Perinatol 2009;29(12):822-5.
38. Murphy K, Weiner J. Use of leukocyte counts in evaluation of early-onset neonatal sepsis Pediatr Infect Dis J. 2012;31(1):16-9.
39. Eyssette-guerreau S, Boize P, Thibault M, Sarda H. [Neonatal parechovirus infection, fever, irritability and myositis]. Arch Pediatr 2013;20(7):772-4.
40. Philip AG. Response of C-reactive protein in neonatal Group B streptococcal infection. Pediatr Infect Dis 1985;4(2):145-8.
41. Van de laar R, Van der ham DP, Oei SG, Willekes C, Weiner CP, Mol BW. Accuracy of C-reactive protein determination in predicting chorioamnionitis and neonatal infection in pregnant women with premature rupture of membranes: a systematic review. Eur J Obstet Gynecol Reprod Biol 2009;147(2):124-9.
42. Boonkasidecha S, Panburana J, Chansakulporn S, Benjasuwantep B, Kongsomboon K. An optimal cut-off point of serum C-reactive protein in prediction of neonatal sepsis. J Med Assoc Thai 2013;96 Suppl 1:S65-70.
43. Enguix A, Rey C, Concha A, Medina A, Coto D, Diéguez MA. Comparison of procalcitonin with C-reactive protein and serum amyloid for the early diagnosis of bacterial sepsis in critically ill neonates and children Intensive Care Med. 2001;27(1):211-5.
44. Schelonka RL, Chai MK, Yoder BA, Hensley D, Brockett RM, Ascher DP. Volume of blood required to detect common neonatal pathogens. J Pediatr 1996;129(2):275-8.
45. Connell TG, Rele M, Cowley D, Buttery JP, Curtis N. How reliable is a negative blood culture result? Volume of blood submitted for culture in routine practice in a children's hospital. Pediatrics 2007;119(5):891-6.
46. Polin JI, Knox I, Baumgart S, Campman E, Mennuti MT, Polin RA. Use of umbilical cord blood culture for detection of neonatal bacteremia. Obstet Gynecol 1981;57(2):233-7.
47. Gabay C, Kushner I. Acute-phase proteins and other systemic responses to inflammation. N Engl J Med 1999;340(6):448-54.
48. Tillett WS, Francis T. SEROLOGICAL REACTIONS IN PNEUMONIA WITH A NON-PROTEIN SOMATIC FRACTION OF PNEUMOCOCCUS. J Exp Med 1930;52(4):561-71.
49. Ingle PV, Patel DM. C- reactive protein in various disease conditionS – an overview. Asian J Pharma Clin Res 2011;4(1):9-13.
50. Gayathri B, Vinodhini VM. High sensitive c-reactive protein and its relationship with other cardiovascular risk variables in obese, overweight and healthy individuals. Asian J Pharma Clin Res 2018;11:194-8.
51. O'callaghan C, Franklin P, Elliott TS, Deverill I, Richards N, Powell RJ. C reactive protein concentrations in neonates: determination by a latex enhanced immunoassay J Clin Pathol. 1984;37(9):1027-8.
52. Mathai E, Christopher U, Mathai M, Jana AK, Rose D, Bergstrom S. Is C-reactive protein level useful in differentiating infected from uninfected neonates among those at risk of infection?. Indian Pediatr 2004;41(9):895-900.
53. Loukovaara MJ, Alfthan HV, Kurki MT, Hiilesmaa VK, Andersson SH. Serum highly sensitive C-reactive protein in preterm premature rupture of membranes. Eur J Obstet Gynecol Reprod Biol 2003;110(1):26-8.
54. Yoon BH, Jun JK, Park KH, Syn HC, Gomez R, Romero R. Serum C-reactive protein, white blood cell count, and amniotic fluid white blood cell count in women with preterm premature rupture of membranes. Obstet Gynecol 1996;88(6):1034-40.
55. Fisk NM, Fysh J, Child AG, Gatenby PA, Jeffery H, Bradfield AH. Is C-reactive protein really useful in preterm premature rupture of the membranes? Br J Obstet Gynaecol 1987;94(12):1159-64.
56. Trochez-martinez RD, Smith P, Lamont RF. Use of C-reactive protein as a predictor of chorioamnionitis in preterm prelabour rupture of membranes: a systematic review. BJOG 2007;114(7):796-801.
57. Stepan M, Cobo T, Musilova I, Hornychova H, Jacobsson B, Kacerovsky M. Maternal Serum C-Reactive Protein in Women with Preterm Prelabor Rupture of Membranes. PLoS ONE 2016;11(3):e0150217.
58. Popowski T, Goffinet F, Maillard F, Schmitz T, Leroy S, Kayem G. Maternal markers for detecting early-onset neonatal infection and chorioamnionitis in cases of premature rupture of membranes at or after 34 weeks of gestation: a two-center prospective study. BMC Pregnancy Childbirth 2011;11:26.
59. Lee SY, Park KH, Jeong EH, Oh KJ, Ryu A, Park KU. Relationship between maternal serum C-reactive protein, funisitis and early-onset neonatal sepsis. J Korean Med Sci 2012;27(6):674-80.
60. Jeon JH, Namgung R, Park MS, Park KI, Lee C. Positive maternal C-reactive protein predicts neonatal sepsis. Yonsei Med J 2014;55(1):113-7.
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BOMMAREDDY, M., & HEBBAR, S. (2019). A REVIEW ON PPROM (PRETERM PRELABOUR RUPTURE OF MEMBRANES) AND EARLY ONSET NEONATAL SEPSIS AND ROLE OF INFLAMMATORY MARKERS IN DIAGNOSIS OF MATERNAL AND NEONATAL INFECTION. Journal of Critical Reviews, 6(3), 7-13. https://doi.org/10.22159/jcr.2019v6i3.31792
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