Maternal-Fetal Infectious Risk and Early Antibiotic Treatment Patterns in Late Preterm and Term Newborns in a Romanian Secondary-Care Maternity: A Six-Month Observational Cohort.

Background

Microbiological confirmation of early-onset neonatal infection is inconsistently available in many secondary-care maternity units, and early management often relies on maternal risk profiles and inflammatory markers.

Objectives

This study aimed to describe maternal infectious risk factors, neonatal biomarkers, and early antibiotic treatment patterns among late preterm and term newborns evaluated for suspected maternal-fetal infection (MFI) in a Romanian secondary-care maternity, and to explore whether a simplified bedside indicator (NeoSIR) corresponded with antibiotic initiation and treatment-related outcomes.

Methods

Observational cohort study (April-September 2024) including newborns with gestational age ≥ 35 weeks evaluated within 24 h for suspected MFI based on maternal risk factors and/or neonatal clinical findings. We recorded maternal infections and screening results, neonatal complete blood count and C-reactive protein (CRP) at 24 h, cultures obtained as part of routine care, antibiotic initiation, treatment duration, and neonatal intensive care unit (NICU) admission.

Results

Among 443 newborns, empirical antibiotics were initiated in 414 (93.5%) and 62 (14.0%) required NICU admission. Maternal urinary tract infection (UTI) documented during pregnancy (recorded diagnosis and/or positive urine culture and/or treatment) was associated with antibiotic initiation (p = 0.005). Elevated CRP (>0.5 mg/dL) was associated with antibiotic selection (p = 0.032) and longer therapy (mean 8.33 vs. 6.98 days, p < 0.001); courses were also longer in NICU-admitted infants (mean 10.39 vs. 6.81 days, p < 0.001). The exploratory two-item NeoSIR indicator (maternal UTI and CRP > 0.5 mg/dL) was feasible to compute but showed limited discrimination for antibiotic initiation in this high-treatment cohort.

Conclusions

In this selected high-risk cohort, antibiotic exposure was highly prevalent and closely associated with maternal urinary tract infection history and neonatal CRP evolution. These findings primarily describe early management patterns in a secondary-care maternity with limited microbiological confirmation and should be interpreted as hypothesis-generating. The exploratory NeoSIR indicator is not intended as a diagnostic or decision-support tool and requires validation against culture-confirmed outcomes in more heterogeneous populations.