Download PDF
Am J Perinatol 2020; 37(S 02): S76-S83
DOI: 10.1055/s-0040-1714257
Original Article

Early- and Late-Respiratory Outcome in Very Low Birth Weight with or without Intrauterine Inflammation

Simona Perniciaro
1   Department of Neonatology, Neonatal Intensive care Unit and Pediatrics, “Filippo Del Ponte” Hospital, University of Insubria, Varese, Italy
,
Jvan Casarin
2   Department of Obstetrics and Gynecology, “Filippo Del Ponte” Hospital, University of Insubria, Varese, Italy
,
Luana Nosetti
1   Department of Neonatology, Neonatal Intensive care Unit and Pediatrics, “Filippo Del Ponte” Hospital, University of Insubria, Varese, Italy
,
Chiara Binda
1   Department of Neonatology, Neonatal Intensive care Unit and Pediatrics, “Filippo Del Ponte” Hospital, University of Insubria, Varese, Italy
,
Silvia Salvatore
1   Department of Neonatology, Neonatal Intensive care Unit and Pediatrics, “Filippo Del Ponte” Hospital, University of Insubria, Varese, Italy
,
Fabio Ghezzi
2   Department of Obstetrics and Gynecology, “Filippo Del Ponte” Hospital, University of Insubria, Varese, Italy
,
Massimo Agosti
1   Department of Neonatology, Neonatal Intensive care Unit and Pediatrics, “Filippo Del Ponte” Hospital, University of Insubria, Varese, Italy
› Author Affiliations Funding None.
› Further Information
Also available at
    Permissions and Reprints

Abstract

• IUI is a risk factor for spontaneous preterm birth and contributes to prematurity-associated mortality and morbidity.

• HCA greatly affected Apgar’s score and lung management of VLBWI at birth and later on with increased incidence of BPD.

• HCA + FUN did not significantly impact on respiratory outcome.

Abstract

Objective Intrauterine inflammation or infection (IUI) is a risk factor for spontaneous preterm birth and contributes to prematurity-associated mortality and morbidity. IUI can include inflammation, as well as infections of varying degrees of severity and duration. Histological chorioamnionitis (HCA) remains the “gold standard” for the diagnosis but clinical, microbiological, and biochemical criteria are often used to define chorioamnionitis. The impact of intrauterine inflammation on respiratory outcome, in infants with very low birth weight, is still unclear and previous data are conflicting showing increase, decrease, or no risk of respiratory complications.

Study Design This is a retrospective study aimed to investigate the role of IUI on neonatal respiratory outcome. Histological criteria (HCA alone and HCA + funisitis [FUN]) and “intrauterine inflammation or infection or both” “Triple I” definition were used; different management in delivery room, in the first 7 days of life (early outcome) and incidence of mild, moderate, and severe bronchopulmonary dysplasia (BPD; late outcome) were considered.

Results A total of 162 infants with very low birth weight (VLBW) with placenta histology were enrolled. Suspected TRIPLE or fever alone was present in 7.4%, and confirmed TRIPLE or HCA in 29.6% of cases (HCA alone 19.1% vs. HCA + FUN 10.5%). Preterm premature rupture of membrane (p-PROM) was strongly associated with HCA (66.6% in HCA group) and HCA was present in 80% neonates born between 22 and 24 weeks of gestational age (GA). HCA group (GA, 26 weeks; birth weight [BW], 880 g) showed lower Apgar's score, higher intubation rate, and need of ventilation in delivery room, surfactant, duration of noninvasive ventilation (NIV), severe patent ductus arteriosus (PDA), and incidence of BPD compared with no-HCA (GA, 30 weeks; BW, 1,210 g). Length of hospital stay and mortality were higher in HCA group (p = 0.01) and an increasing trend was present for HCA + FUN compared with HCA alone.

Conclusion HCA greatly affected Apgar's score and lung management of VLBW infants (VLBWI) at birth and later on with increased incidence of BPD, thus impacting length of stay and quality of life, while HCA + FUN did not significantly impact on respiratory outcome. Further studies are needed to clarify the role of HCA and FUN in VLBW neonates.

Keywords

very low birth weight - histological chorioamnionitis - histological funisitis

Authors' Contributions

S.P., C.B., and M.A. contributed to the scope and setup of the study. J.C. and F.G. performed statistical analysis. L.N. and S.S. supported discussion and all authors wrote and approved the final version of manuscript.




Publication History

Article published online:
08 September 2020

Thieme Medical Publishers
333 Seventh Avenue, New York, NY 10001, USA.

 

  • References

  • 1 Kim CJ, Romero R, Chaemsaithong P, Chaiyasit N, Yoon BH, Kim YM. Acute chorioamnionitis and funisitis: definition, pathologic features, and clinical significance. Am J Obstet Gynecol 2015; 213 (04) S29-S52
    CrossrefPubMedGoogle Scholar
  • 2 Goldenberg RL, Hauth JC, Andrews WW. Intrauterine infection and preterm delivery. N Engl J Med 2000; 342 (20) 1500-1507
    CrossrefPubMedGoogle Scholar
  • 3 Thomas W, Speer CP. Chorioamnionitis: important risk factor or innocent bystander for neonatal outcome?. Neonatology 2011; 99 (03) 177-187
    CrossrefPubMedGoogle Scholar
  • 4 Hagberg H, Wennerholm UB, Sävman K. Sequelae of chorioamnionitis. Curr Opin Infect Dis 2002; 15 (03) 301-306
    CrossrefPubMedGoogle Scholar
  • 5 Andrews WW, Goldenberg RL, Faye-Petersen O, Cliver S, Goepfert AR, Hauth JC. The Alabama Preterm Birth study: polymorphonuclear and mononuclear cell placental infiltrations, other markers of inflammation, and outcomes in 23- to 32-week preterm newborn infants. Am J Obstet Gynecol 2006; 195 (03) 803-808
    CrossrefPubMedGoogle Scholar
  • 6 Leviton A, Allred EN, Kuban KC. , et al. Microbiologic and histologic characteristics of the extremely preterm infant's placenta predict white matter damage and later cerebral palsy. the ELGAN study. Pediatr Res 2010; 67 (01) 95-101
    CrossrefPubMedGoogle Scholar
  • 7 Sweeney EL, Dando SJ, Kallapur SG, Knox CL. The human ureaplasma species as causative agents of chorioamnionitis. Clin Microbiol Rev 2016; 30 (01) 349-379
    CrossrefPubMedGoogle Scholar
  • 8 Maki Y, Fujisaki M, Sato Y, Sameshima H. Candida chorioamnionitis leads to preterm birth and adverse fetal-neonatal outcome. Infect Dis Obstet Gynecol 2017; 2017: 9060138
    CrossrefPubMedGoogle Scholar
  • 9 Pereira L. Congenital viral infection: traversing the uterine- placental interface. Annu Rev Virol 2018; 5 (01) 273-299
    CrossrefPubMedGoogle Scholar
  • 10 Pugni L, Pietrasanta C, Acaia B. , et al. Chorioamnionitis and neonatal outcome in preterm infants: a clinical overview. J Matern Fetal Neonatal Med 2016; 29 (09) 1525-1529
    CrossrefPubMedGoogle Scholar
  • 11 Redline RW, Faye-Petersen O, Heller D, Qureshi F, Savell V, Vogler C. Society for Pediatric Pathology, Perinatal Section, Amniotic Fluid Infection Nosology Committee. Amniotic infection syndrome: nosology and reproducibility of placental reaction patterns. Pediatr Dev Pathol 2003; 6 (05) 435-448
    CrossrefPubMedGoogle Scholar
  • 12 Edwards RK. Chorioamnionitis and labor. Obstet Gynecol Clin North Am 2005; 32 (02) 287-296 , x
    CrossrefPubMedGoogle Scholar
  • 13 Cappelletti M, Presicce P, Kallapur SG. Immunobiology of acute chorioamnionitis. Front Immunol 2020; 11: 649
    CrossrefPubMedGoogle Scholar
  • 14 Gomez R, Romero R, Ghezzi F, Yoon BH, Mazor M, Berry SM. The fetal inflammatory response syndrome. Am J Obstet Gynecol 1998; 179 (01) 194-202
    CrossrefPubMedGoogle Scholar
  • 15 Pacora P, Chaiworapongsa T, Maymon E. , et al. Funisitis and chorionic vasculitis: the histological counterpart of the fetal inflammatory response syndrome. J Matern Fetal Neonatal Med 2002; 11 (01) 18-25
    CrossrefPubMedGoogle Scholar
  • 16 Yoon BH, Romero R, Park JS. , et al. The relationship among inflammatory lesions of the umbilical cord (funisitis), umbilical cord plasma interleukin 6 concentration, amniotic fluid infection, and neonatal sepsis. Am J Obstet Gynecol 2000; 183 (05) 1124-1129
    CrossrefPubMedGoogle Scholar
  • 17 Higgins RD, Saade G, Polin RA. , et al; Chorioamnionitis Workshop Participants. Evaluation and management of women and newborns with a maternal diagnosis of chorioamnionitis: summary of a workshop. Obstet Gynecol 2016; 127 (03) 426-436
    CrossrefPubMedGoogle Scholar
  • 18 Kramer BW, Kallapur S, Newnham J, Jobe AH. Prenatal inflammation and lung development. Semin Fetal Neonatal Med 2008; 14 (01) 2-7
    CrossrefPubMedGoogle Scholar
  • 19 Pietrasanta C, Pugni L, Merlo D. , et al. Impact of different stages of intrauterine inflammation on outcome of preterm neonates: gestational age-dependent and -independent effect. PLoS One 2019; 14 (02) e0211484
    CrossrefPubMedGoogle Scholar
  • 20 Lahra MM, Beeby PJ, Jeffery HE. Intrauterine inflammation, neonatal sepsis, and chronic lung disease: a 13-year hospital cohort study. Pediatrics 2009; 123 (05) 1314-1319
    CrossrefPubMedGoogle Scholar
  • 21 Pappas A, Kendrick DE, Shankaran S. , et al; Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network. Chorioamnionitis and early childhood outcomes among extremely low-gestational-age neonates. JAMA Pediatr 2014; 168 (02) 137-147
    CrossrefPubMedGoogle Scholar
  • 22 Park HW, Choi YS, Kim KS, Kim SN. Chorioamnionitis and patent ductus arteriosus: a systematic review and meta-analysis. PLoS One 2015; 10 (09) e0138114
    CrossrefPubMedGoogle Scholar
  • 23 Shi Z, Ma L, Luo K. , et al. Chorioamnionitis in the development of cere- bral palsy: a meta-analysis and systematic review. Pediatrics 2017; 139 (06) e20163781-e17
    CrossrefPubMedGoogle Scholar
  • 24 Jobe A. Effects of chorioamnionitis on fetal lung. Clin Perinatol 2012; 39 (03) 441-457
    CrossrefPubMedGoogle Scholar
  • 25 Been JV, Degraeuwe PL, Kramer BW, Zimmermann LJ. Antenatal steroids and neonatal outcome after chorioamnionitis: a meta-analysis. BJOG 2011; 118 (02) 113-122
    CrossrefPubMedGoogle Scholar
  • 26 Lee J, Oh KJ, Park CW, Park JS, Jun JK, Yoon BH. The presence of funisitis is associated with a decreased risk for the development of neonatal respiratory distress syndrome. Placenta 2011; 32 (03) 235-240
    CrossrefPubMedGoogle Scholar
  • 27 Plakkal N, Soraisham AS, Trevenen C, Freiheit EA, Sauve R. Histological chorioamnionitis and bronchopulmonary dysplasia: a retrospective cohort study. J Perinatol 2013; 33 (06) 441-445
    CrossrefPubMedGoogle Scholar
  • 28 Hartling L, Liang Y, Lacaze-Masmonteil T. Chorioamnionitis as a risk factor for bronchopulmonary dysplasia: a systematic review and meta-analysis. Arch Dis Child Fetal Neonatal Ed 2012; 97 (01) F8-F17
    CrossrefPubMedGoogle Scholar
  • 29 Ballard AR, Mallett LH, Pruszynski JE, Cantey JB. Chorioamnionitis and subsequent bronchopulmonary dysplasia in very-low-birth weight infants: a 25-year cohort. J Perinatol 2016; 36 (12) 1045-1048
    CrossrefPubMedGoogle Scholar
  • 30 Torchin H, Lorthe E, Goffinet F. , et al. Histologic chorioamnionitis and bronchopulmonary dysplasia in preterm infants: the epidemiologic study on low gestational ages 2 cohort. J Pediatr 2017; 187: 98-104.e3
    CrossrefPubMedGoogle Scholar
  • 31 Jobe AH. Mechanisms of lung injury and bronchopulmonary dysplasia. Am J Perinatol 2016; 33 (11) 1076-1078
    Article in Thieme ConnectPubMedGoogle Scholar
  • 32 Watterberg KL, Demers LM, Scott SM, Murphy S. Chorioamnionitis and early lung inflammation in infants in whom bronchopulmonary dysplasia develops. Pediatrics 1996; 97 (02) 210-215
    CrossrefPubMedGoogle Scholar
  • 33 Been JV, Zimmermann LJ. Histological chorioamnionitis and respiratory outcome in preterm infants. Arch Dis Child Fetal Neonatal Ed 2009; 94 (03) F218-F225
    CrossrefPubMedGoogle Scholar
  • 34 Viscardi RM. Perinatal inflammation and lung injury. Semin Fetal Neonatal Med 2012; 17 (01) 30-35
    CrossrefPubMedGoogle Scholar
  • 35 Villamor-Martinez E, Álvarez-Fuente M, Ghazi AMT. , et al. Association of chorioamnionitis with bronchopulmonary dysplasia among preterm infants: a systematic review, meta-analysis, and metaregression. JAMA Netw Open 2019; 2 (11) e1914611
    CrossrefPubMedGoogle Scholar
  • 36 Jobe AH, Bancalari E. Bronchopulmonary dysplasia. Am J Respir Crit Care Med 2001; 163 (07) 1723-1729
    CrossrefPubMedGoogle Scholar