FETUS, PLACENTA, AND NEWBORN
Neonatal scalp abscess and fetal monitoring: associated with infection DONALD
M.
ANTHONY
W.
VIRGINIA Tr~rmncu,
OKADA.
T.
CHOW, BRUCE,
Factors
M.D. M.D. P.N.P.
California
Forty-two of 929 (4.5 per cent) newborn infants prospecGvely studied following conQnuous, direct fetal heart rate monitoring during labor developed a scalp abscess at the site of electrode application during the neonatal period. Factors associated with infection with the use of a multivariate analysis were duration of monitoring (p < 0.01) and high-risk indications for monitoring (p < 0.01). Of the 42 infected neonates, 33 had complete bacteriologic studies. Microorganisms were isolated from all; the infection tended to be polymicrobial, most commonly containing both aerobes and anaerobes. Staphylococcus epidermidis, Streptococcus, Peptostreptococcus, and Peptococcus were the predominant isolates. These data indicate that scalp abscess complicating intrapartum fetal monitoring may be of nosocomial importance, and infants monitored should be closely observed in order to prevent more serious infectious complications. (AM. J. OBSTET. GYNECOL. 129: 185, 1977.)
NEONATAL SCALP ABSCESS complicating intraparturn fetal monitoring with a spiral electrode has a reported incidence varying from 0 to 5.4 per cent by retrospective study.‘-* We found an incidence of 4.5 per cent among 929 newborn infants in a prospective study of this complication.g
Although the majority of these infections have been minor and self-limiting, more serious and potentially life-threatening complications such as cranial osteomyelitis, generalized sepsis, and subgaleal abscess have been reported.‘j, 7* ‘O-l* This communication examines the factors associated with and the microbiology of these infections in a prospective study design.
Fwm the Department of Obstetrics and Gynecology, Medicine, Division of Infectious Disease, and Pediatrics, Harbor General Hospital, University of California at Los .4ngelr.s School of Medicine.
Materials and methods Study subjects. Between February 1, 1976, and July 31, 1976, all patients delivered at Harbor General Hospital who had direct fetal heart rate monitoring with a spiral electrode during labor were studied. The study population consisted of 929 neonates monitored during labor, which represented 54.1 per cent of 1.7 18 fetuses accessible for continuous fetal monitoring. Neonatal evaluation. In addition to routine care in the nursery, the scalp hair around the site of previous electrode application was clipped for easier serial ob-
Computing nsswtance wan obtained from the Health Sciences Computing Facilit?, Unizjersity of California at Los Angeles School of Mrdzcine, supported by National I&itutes of Health special research resources Grant RR-3. Rrceiwd
for publication
.4ccepted April
January
31, 1977.
29, 1977.
Reprint requests: Dr. Anthony W. Chow, Division of Infectious Disease, Department of Medicine, Harbor C;PnPmlHospital, 1000 W. Carson St., Torrance, Cnlifkrnia 90509. 185
186
Okada, Chow, and Bruce
Table
I. Factors
associated
with
scalp
abscess
complicating
intrapartum
fetal
monitoring P valur
Parameter Internal
Abscess (42)
monitoring
(hours)
6.3 k 0.6t
Indication for monitoring High risk Normal Ruptured
Uninfected
(hours)
12.4 t
Parity Nulliparous Multiparous
Univariate
3.9 f 0.1
36 6
membranes
(887)
MultLL’Url&
Neonatal scalp abscess and fetal monitoring: associated with infection DONALD
M.
ANTHONY
W.
VIRGINIA Tr~rmncu,
OKADA.
T.
CHOW, BRUCE,
Factors
M.D. M.D. P.N.P.
California
Forty-two of 929 (4.5 per cent) newborn infants prospecGvely studied following conQnuous, direct fetal heart rate monitoring during labor developed a scalp abscess at the site of electrode application during the neonatal period. Factors associated with infection with the use of a multivariate analysis were duration of monitoring (p < 0.01) and high-risk indications for monitoring (p < 0.01). Of the 42 infected neonates, 33 had complete bacteriologic studies. Microorganisms were isolated from all; the infection tended to be polymicrobial, most commonly containing both aerobes and anaerobes. Staphylococcus epidermidis, Streptococcus, Peptostreptococcus, and Peptococcus were the predominant isolates. These data indicate that scalp abscess complicating intrapartum fetal monitoring may be of nosocomial importance, and infants monitored should be closely observed in order to prevent more serious infectious complications. (AM. J. OBSTET. GYNECOL. 129: 185, 1977.)
NEONATAL SCALP ABSCESS complicating intraparturn fetal monitoring with a spiral electrode has a reported incidence varying from 0 to 5.4 per cent by retrospective study.‘-* We found an incidence of 4.5 per cent among 929 newborn infants in a prospective study of this complication.g
Although the majority of these infections have been minor and self-limiting, more serious and potentially life-threatening complications such as cranial osteomyelitis, generalized sepsis, and subgaleal abscess have been reported.‘j, 7* ‘O-l* This communication examines the factors associated with and the microbiology of these infections in a prospective study design.
Fwm the Department of Obstetrics and Gynecology, Medicine, Division of Infectious Disease, and Pediatrics, Harbor General Hospital, University of California at Los .4ngelr.s School of Medicine.
Materials and methods Study subjects. Between February 1, 1976, and July 31, 1976, all patients delivered at Harbor General Hospital who had direct fetal heart rate monitoring with a spiral electrode during labor were studied. The study population consisted of 929 neonates monitored during labor, which represented 54.1 per cent of 1.7 18 fetuses accessible for continuous fetal monitoring. Neonatal evaluation. In addition to routine care in the nursery, the scalp hair around the site of previous electrode application was clipped for easier serial ob-
Computing nsswtance wan obtained from the Health Sciences Computing Facilit?, Unizjersity of California at Los Angeles School of Mrdzcine, supported by National I&itutes of Health special research resources Grant RR-3. Rrceiwd
for publication
.4ccepted April
January
31, 1977.
29, 1977.
Reprint requests: Dr. Anthony W. Chow, Division of Infectious Disease, Department of Medicine, Harbor C;PnPmlHospital, 1000 W. Carson St., Torrance, Cnlifkrnia 90509. 185
186
Okada, Chow, and Bruce
Table
I. Factors
associated
with
scalp
abscess
complicating
intrapartum
fetal
monitoring P valur
Parameter Internal
Abscess (42)
monitoring
(hours)
6.3 k 0.6t
Indication for monitoring High risk Normal Ruptured
Uninfected
(hours)
12.4 t
Parity Nulliparous Multiparous
Univariate
3.9 f 0.1
36 6
membranes
(887)
MultLL’Url&
