Prolonged rupture of membranes in term infants: should all babies be screened?
Christopher Flannigan,1 Martina Hogan,2
1Royal Jubilee Maternity Hospital, Regional Neonatal Unit, Belfast, Northern Ireland; 2Craigavon Area Hospital, Neonatal Unit, Portadown, Northern Ireland
Background: Prolonged rupture of fetal membranes (>24 hours) is a major risk factor for early onset sepsis in neonates. In Northern Ireland there is no consistency on the management of this problem and individual clinical guidelines vary widely between neonatal departments. At present in Craigavon Area Hospital all term babies born with prolonged rupture fetal membranes have screening blood analysis performed, regardless of what is found on risk factor assessment.
Setting: The neonatal department of Craigavon Area Hospital a district general hospital in Northern Ireland.
Objectives: To determine if the current guidelines on the management of prolonged rupture of fetal membranes in term infants are being followed. The audit will also try to determine if the decision on whether to perform screening blood analysis was left up to the individual doctor’s clinical judgment, would they make a safe decision.
Design: A prospective audit was carried out over a three-month period between October 2008 and January 2009. Term infants born during this period where fetal membranes had ruptured for more than 24 hours prior to delivery were included in the audit.
Results: At present there is 100% compliance with the current hospital guidelines and there is evidence that if the decision of whether to perform screening blood analysis is left up to the individual doctor’s clinical judgment, they will make a sensible decision based on the infants risk factor assessment. None of the infants that the doctor decided they wouldn’t screen came to any harm.
Conclusion: Combining the results of the audit and the availability of nationally recognized guidelines it was decided to adopt the National Institute for Health and Clinical Excellence (NICE) guidelines in Craigavon Hospital. To help facilitate this change a neonatal early warning score (NEWS) observation chart has been developed to record the observations recommended by NICE. As there has been a major change in the management of this condition it is planned to re-audit in the near future to ensure that adopting this less invasive strategy does not result in any increase in adverse neonatal outcomes.
Keywords: prolonged rupture of fetal membranes, neonatal, sepsis, audit
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