Advocate Lutheran General Hospital

Advocate Children's Hospital

Presentation Notes

Poster presented at: Building Bridges to Nursing Research; May 13, 2022; Milwaukee, WI.


Background or Significance: Intrapartum and neonatal antibiotic use is prevalent, to battle infection and as a prophylactic intervention. However, exposure during labor and early neonatal life significantly impacts the neonate’s microbiome which can lead to lifelong health consequences.

Purpose of the project or study: Chorioamnionitis is an infection of the placenta and amniotic membranes. The Center for Disease Control (CDC, 2010) recommended that all neonates born to mothers with suspected chorioamnionitis have blood cultures and a CBC drawn, followed by prophylactic antibiotics for 36 hours. The purpose of this project has been to implement interventions aimed at reducing chorioamnionitis during labor and utilize an assessment tool to evaluate the risk of early onset sepsis to the neonates exposed to chorioamnionitis, thereby decreasing unnecessary antibiotics.

Results or Outcomes: L&D nurses initiated a quality improvement project to reduce the incidence of intrapartum chorioamnionitis. The interventions included decreasing the number of vaginal exams and performing perineal care every two hours. The interventions led to a 40% reduction in chorioamnionitis. A review of the blood cultures of infants exposed to chorioamnionitis demonstrated that 100% were negative and the antibiotics received were unnecessary. The American Academy of Pediatrics recently endorsed the use of a multivariate risk assessment neonatal sepsis calculator which demonstrated a reduction of antibiotic administration without apparent adverse effects among neonates born at 35 weeks of gestation. The use of this calculator was initiated in January 2020. Since implementation, the antibiotic use for asymptomatic infants has decreased by 96%, protecting the microbiomes of these infants as well as saving thousands of health care dollars.

Conclusions and Implications: Labor and Delivery nurses are well positioned to reduce the incidence of chorioamnionitis. For infants that are exposed to chorioamnionitis, the need for antibiotics should be evaluated using a risk benefit model.

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