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Rana M, Vega Gonzales-Portillo JD, Hahn C, Dutt M, Sanchez-Fernandez I, Jonas R, Douglass L, Torres AR. Current Evidence: Seizures in Extremely Low Gestational Age Newborns (ELGANs). J Child Neurol 2024; 39:285-291. [PMID: 38836290 DOI: 10.1177/08830738241259052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/06/2024]
Abstract
Extremely low gestational age newborns (ELGANs) are born at or below 28 weeks of gestational age. Despite improved obstetric care, the incidence of preterm birth continues to rise in advanced countries. Preterm birth remains a major cause of infant mortality, and for infants who survive, neonatal seizures are a significant predictor of later neurologic morbidity. However, little is known about risk factors for neonatal seizures in ELGANs. Understanding the association between neonatal seizures and the development of other neurologic disorders is important given the increasing prevalence of ELGANs. Identifying risk factors that contribute to the development of neonatal seizures in ELGANs may offer insights into novel mechanisms of epileptogenesis in the developing brain and improvements in the prevention or treatment of seizures in preterm infants, including ELGANs. In this literature review, we outline the limitations of epidemiologic studies of neonatal seizures in ELGANs and discuss risk factors for neonatal seizures.
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Affiliation(s)
- Mandeep Rana
- Division of Pediatric Neurology and Sleep Medicine, Department of Pediatrics, Boston University School of Medicine, Boston Medical Center, Boston, MA, USA
| | - Juan Diego Vega Gonzales-Portillo
- Division of Pediatric Neurology, Department of Pediatrics, Boston Medical Center, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | - Cecil Hahn
- Division of Neurology, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Monideep Dutt
- Division of Pediatric Neurology, Children's Healthcare of Atlanta: Pediatric Institute, Emory University, Atlanta, GA, USA
| | - Ivan Sanchez-Fernandez
- Division of Pediatric Neurology, Department of Pediatrics, Boston Medical Center, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | - Rinat Jonas
- Division of Pediatric Neurology, Department of Pediatrics, Boston Medical Center, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | - Laurie Douglass
- Division of Pediatric Neurology, Department of Pediatrics, Boston Medical Center, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | - Alcy R Torres
- Division of Pediatric Neurology, Department of Pediatrics, Boston Medical Center, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
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Nijman M, van der Meeren LE, Nikkels PGJ, Stegeman R, Breur JMPJ, Jansen NJG, ter Heide H, Steenhuis TJ, de Heus R, Bekker MN, Claessens NHP, Benders MJNL. Placental Pathology Contributes to Impaired Volumetric Brain Development in Neonates With Congenital Heart Disease. J Am Heart Assoc 2024; 13:e033189. [PMID: 38420785 PMCID: PMC10944035 DOI: 10.1161/jaha.123.033189] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Accepted: 12/01/2023] [Indexed: 03/02/2024]
Abstract
BACKGROUND Neonates with congenital heart disease are at risk for impaired brain development in utero, predisposing children to postnatal brain injury and adverse long-term neurodevelopmental outcomes. Given the vital role of the placenta in fetal growth, we assessed the incidence of placental pathology in fetal congenital heart disease and explored its association with total and regional brain volumes, gyrification, and brain injury after birth. METHODS AND RESULTS Placentas from 96 term singleton pregnancies with severe fetal congenital heart disease were prospectively analyzed for macroscopic and microscopic pathology. We applied a placental pathology severity score to relate placental abnormalities to neurological outcome. Postnatal, presurgical magnetic resonance imaging was used to analyze brain volumes, gyrification, and brain injuries. Placental analyses revealed the following abnormalities: maternal vascular malperfusion lesions in 46%, nucleated red blood cells in 37%, chronic inflammatory lesions in 35%, delayed maturation in 30%, and placental weight below the 10th percentile in 28%. Severity of placental pathology was negatively correlated with cortical gray matter, deep gray matter, brainstem, cerebellar, and total brain volumes (r=-0.25 to -0.31, all P<0.05). When correcting for postmenstrual age at magnetic resonance imaging in linear regression, this association remained significant for cortical gray matter, cerebellar, and total brain volume (adjusted R2=0.25-0.47, all P<0.05). CONCLUSIONS Placental pathology occurs frequently in neonates with severe congenital heart disease and may contribute to impaired brain development, indicated by the association between placental pathology severity and reductions in postnatal cortical, cerebellar, and total brain volumes.
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Affiliation(s)
- Maaike Nijman
- Department of NeonatologyWilhelmina Children’s Hospital, University Medical Center UtrechtUtrechtthe Netherlands
- Department of Pediatric CardiologyWilhelmina Children’s Hospital, University Medical Center UtrechtUtrechtthe Netherlands
| | - Lotte E. van der Meeren
- Department of PathologyErasmus Medical Center RotterdamRotterdamthe Netherlands
- Department of PathologyLeiden University Medical CenterLeidenthe Netherlands
| | - Peter G. J. Nikkels
- Department of PathologyUniversity Medical Center UtrechtUtrechtthe Netherlands
| | - Raymond Stegeman
- Department of NeonatologyWilhelmina Children’s Hospital, University Medical Center UtrechtUtrechtthe Netherlands
- Department of Pediatric CardiologyWilhelmina Children’s Hospital, University Medical Center UtrechtUtrechtthe Netherlands
- Department of PediatricsBeatrix Children’s Hospital, University Medical Center GroningenGroningenthe Netherlands
| | - Johannes M. P. J. Breur
- Department of Pediatric CardiologyWilhelmina Children’s Hospital, University Medical Center UtrechtUtrechtthe Netherlands
| | - Nicolaas J. G. Jansen
- Department of PediatricsBeatrix Children’s Hospital, University Medical Center GroningenGroningenthe Netherlands
| | - Henriette ter Heide
- Department of Pediatric CardiologyWilhelmina Children’s Hospital, University Medical Center UtrechtUtrechtthe Netherlands
| | - Trinette J. Steenhuis
- Department of Pediatric CardiologyWilhelmina Children’s Hospital, University Medical Center UtrechtUtrechtthe Netherlands
| | - Roel de Heus
- Department of Obstetrics and GynecologyUniversity Medical Center UtrechtUtrechtthe Netherlands
- Department of Obstetrics and GynecologySt. Antonius HospitalUtrechtthe Netherlands
| | - Mireille N. Bekker
- Department of Obstetrics and GynecologyUniversity Medical Center UtrechtUtrechtthe Netherlands
| | - Nathalie H. P. Claessens
- Department of NeonatologyWilhelmina Children’s Hospital, University Medical Center UtrechtUtrechtthe Netherlands
- Department of PediatricsWilhelmina Children’s Hospital, University Medical Center UtrechtUtrechtthe Netherlands
| | - Manon J. N. L. Benders
- Department of NeonatologyWilhelmina Children’s Hospital, University Medical Center UtrechtUtrechtthe Netherlands
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Negishi Y, Shima Y, Kato M, Ichikawa T, Ino H, Horii Y, Suzuki S, Morita R. Inflammation in preterm birth: Novel mechanism of preterm birth associated with innate and acquired immunity. J Reprod Immunol 2022; 154:103748. [PMID: 36126439 DOI: 10.1016/j.jri.2022.103748] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 08/26/2022] [Accepted: 09/11/2022] [Indexed: 12/14/2022]
Abstract
Preterm birth (PB) is the most-frequent complication occurring during pregnancy, with a significant impact on neonatal morbidity and mortality. Chorioamnionitis (CAM), the neutrophil infiltration into chorioamniotic membranes, is a major cause of PB. However, several cases of PB have also been reported without apparent pathogenic infection or CAM. Such cases are now attributed to "sterile inflammation." The concept of sterile inflammation has already attracted attention in various diseases, like cardiovascular diseases, diabetes, and autoimmune diseases; recently been discussed for obstetric complications such as miscarriage, PB, gestational hypertension, and gestational diabetes. Sterile inflammation is induced by alarmins, such as high-mobility group box 1 (HMGB1), interleukins (IL-33 and IL-1α), and S100 proteins, that are released by cellular damage without apparent pathogenic infection. These antigens are recognized by pattern-recognition receptors, expressed mainly on antigen-presenting cells of decidua, placenta, amnion, and myometrium, which consequently trigger inflammation. In reproduction, these alarmins are associated with the development of various pregnancy complications, including PB. In this review, we have summarized the development of PB related to acute CAM, chronic CAM, and sterile inflammation as well as proposed a new mechanism for PB that involves innate immunity, acquired immunity, and sterile inflammation.
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Affiliation(s)
- Yasuyuki Negishi
- Department of Microbiology and Immunology, Nippon Medical School, Tokyo, Japan; Department of Obstetrics and Gynecology, Nippon Medical School, Tokyo, Japan.
| | - Yoshio Shima
- Department of Pediatrics, Nippon Medical School Musashikosugi Hospital, Kanagawa, Japan.
| | - Masahiko Kato
- Department of Obstetrics and Gynecology, Nippon Medical School, Tokyo, Japan.
| | - Tomoko Ichikawa
- Department of Obstetrics and Gynecology, Nippon Medical School, Tokyo, Japan.
| | - Hajime Ino
- Department of Microbiology and Immunology, Nippon Medical School, Tokyo, Japan; Department of Obstetrics and Gynecology, Nippon Medical School, Tokyo, Japan.
| | - Yumi Horii
- Department of Microbiology and Immunology, Nippon Medical School, Tokyo, Japan; Department of Obstetrics and Gynecology, Nippon Medical School, Tokyo, Japan.
| | - Shunji Suzuki
- Department of Obstetrics and Gynecology, Nippon Medical School, Tokyo, Japan.
| | - Rimpei Morita
- Department of Microbiology and Immunology, Nippon Medical School, Tokyo, Japan.
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Do the Causes of Spontaneous Preterm Delivery Affect Placental Inflammatory Pathology and Neonatal Outcomes? Diagnostics (Basel) 2022; 12:diagnostics12092126. [PMID: 36140528 PMCID: PMC9498177 DOI: 10.3390/diagnostics12092126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 08/03/2022] [Accepted: 08/26/2022] [Indexed: 11/17/2022] Open
Abstract
Objective: To investigate the severity of histologic chorioamnionitis /funisitis according to the indication for preterm delivery and their corresponding neonatal outcomes. Method: This study included 411 singleton women who delivered between 21+0 and 31+6 week of gestation due to preterm labor (PTL, n = 165), preterm premature rupture of membranes (PPROM, n = 202), or incompetent internal os of the cervix (IIOC, n = 44). The primary outcome measure was the rate of severe histological chorioamnionitis/funisitis. Secondary outcome measure was neonatal outcomes including neonatal and infant death, and neonatal composite morbidity. Results: The PPROM group demonstrated a higher rate of severe histological chorioamnionitis/funisitis compared to the PTL group (severe histological chorioamnionitis; PPROM, 66.3% vs. PTL, 49.1%, p = 0.001, severe funisitis; PPROM, 44.1% vs. PTL, 23.6%, p < 0.001) and this remained significant after multivariable analysis (severe histologic chorioamnionitis, OR 2.367, 95% CI 1.517−3.693; severe funisitis, OR 2.668, 95% CI 1.684−4.226). For neonatal outcomes only, a higher rate of patent ductus arteriosus was observed in the IIOC group compared to the PTL and PPROM groups (IIOC, 77.3% vs. PTL, 54.0% vs. PPROM, 54.0%, p = 0.043) and this remained significant after multivariable analysis. Conclusion: Indication of spontaneous preterm delivery might affect the placental inflammatory pathology and neonatal morbidity.
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Abiramalatha T, Bandyopadhyay T, Ramaswamy VV, Shaik NB, Thanigainathan S, Pullattayil AK, Amboiram P. Risk Factors for Periventricular Leukomalacia in Preterm Infants: A Systematic Review, Meta-analysis, and GRADE-Based Assessment of Certainty of Evidence. Pediatr Neurol 2021; 124:51-71. [PMID: 34537463 DOI: 10.1016/j.pediatrneurol.2021.08.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Revised: 07/20/2021] [Accepted: 08/12/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND We analyzed the certainty of evidence (CoE) for risk factors of periventricular leukomalacia (PVL) in preterm neonates, a common morbidity of prematurity. METHODS Medline, CENTRAL, Embase, and CINAHL were searched. Cohort and case-control studies and randomised randomized controlled trials were included. Data extraction was performed in duplicate. A random random-effects meta-analysis was utilizedused. CoE was evaluated as per Grading of Recommendations Assessment, Development and Evaluation (GRADE) guidelines. RESULTS One hundred eighty-six studies evaluating 95 risk factors for PVL were included. Of the 2,509,507 neonates assessed, 16,569 were diagnosed with PVL. Intraventricular hemorrhage [adjusted odds ratio: 3.22 (2.52-4.12)] had moderate CoE for its association with PVL. Other factors such as hypocarbia, chorioamnionitis, PPROM >48 hour, multifetal pregnancy reduction, antenatal indomethacin, lack of antenatal steroids, perinatal asphyxia, ventilation, shock/hypotension, patent ductus arteriosus requiring surgical ligation, late-onset circulatory collapse, sepsis, necrotizing enterocolitis, and neonatal surgery showed significant association with PVL after adjustment for confounders (CoE: very low to low). Amongst the risk factors associated with mother placental fetal (MPF) triad, there was paucity of literature related to genetic predisposition and defective placentation. Sensitivity analysis revealed that the strength of association between invasive ventilation and PVL decreased over time (P < 0.01), suggesting progress in ventilation strategies. Limited studies had evaluated diffuse PVL. CONCLUSION Despite decades of research, our findings indicate that the CoE is low to very low for most of the commonly attributed risk factors of PVL. Future studies should evaluate genetic predisposition and defective placentation in the MPF triad contributing to PVL. Studies evaluating exclusively diffuse PVL are warranted.
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Affiliation(s)
- Thangaraj Abiramalatha
- Department of Neonatology, Sri Ramachandra Institute of Higher Education and Research, Chennai, India
| | - Tapas Bandyopadhyay
- Department of Neonatology, Dr Ram Manohar Lohia Hospital & Post Graduate Institute of Medical Education and Research, New Delhi, India
| | | | - Nasreen Banu Shaik
- Department of Neonatology, Ankura Hospital for Women and Children, Hyderabad, India
| | - Sivam Thanigainathan
- Department of Neonatology, All India Institute of Medical Sciences, Jodhpur, India
| | | | - Prakash Amboiram
- Department of Neonatology, Sri Ramachandra Institute of Higher Education and Research, Chennai, India
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He L, Yang H, Feng J, Wei T, Huang Y, Zhang X, Wang Z. Knockdown of G protein-coupled receptor-17 (GPR17) facilitates the regeneration and repair of myelin sheath post-periventricular leukomalacia (PVL). Bioengineered 2021; 12:7314-7324. [PMID: 34569901 PMCID: PMC8806752 DOI: 10.1080/21655979.2021.1979352] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
The G protein-coupled receptor-17 (GPR17) plays an important role in regulating the differentiation of oligodendrocytes and remyelination, which is a key negative regulator of oligodendrocyte differentiation. The present study aimed to investigate the function of GPR17 in the white matter of periventricular leukomalacia (PVL) neonatal rats. The PVL model was established in 2-day old neonatal rats by intracerebral injection of LPS (1 mg/kg). Compared to sham, GPR17 was significantly upregulated, while Olig1 was significantly downregulated in the PVL group at 1 d, 3 days, and 7 days post-modeling. Compared to the negative control (NC) group, the expression of GPR17 was suppressed, while that of Olig1 was elevated in the siRNA-GPR17 group as time progressed; the opposite results were observed in the GPR17-overexpressed group. Decreased formation of myelin sheaths as well as poor structure and loose arrangement were observed in the PVL group. Similar observations were found in the PVL + siRNA-GPR17 group at 1 d and 3 days post-modeling. However, on day 7 post-modeling, a dramatic increase in the formation of myelin sheath as well as thicker myelin sheaths were observed in the PVL + siRNA-GPR17 group. The migration ability of oligodendrocyte progenitor cells (OPCs) isolated from animals was found to be significantly suppressed in the GPR17-overexpressed group, accompanied by the downregulation of Olig1. Taken together, the regeneration and repair of myelin sheaths post-PVL white matter injury were induced by downregulating the GPR17 gene, which elevated the expression of Olig1.
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Affiliation(s)
- Liufang He
- Department of Neonatology, Affiliated Longhua People's Hospital, Southern Medical University (Longhua People's Hospital), Shenzhen, China
| | - Hui Yang
- Department of Neonatology, Shenzhen Children Hospital, Shenzhen, China
| | - Jinxing Feng
- Department of Neonatology, Shenzhen Children Hospital, Shenzhen, China
| | - Tingyan Wei
- Department of Neonatology, Affiliated Longhua People's Hospital, Southern Medical University (Longhua People's Hospital), Shenzhen, China
| | - Yong Huang
- Department of Neonatology, Affiliated Longhua People's Hospital, Southern Medical University (Longhua People's Hospital), Shenzhen, China
| | - Xueli Zhang
- Department of Neonatology, Affiliated Longhua People's Hospital, Southern Medical University (Longhua People's Hospital), Shenzhen, China
| | - Zhangxing Wang
- Department of Neonatology, Affiliated Longhua People's Hospital, Southern Medical University (Longhua People's Hospital), Shenzhen, China
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Urushiyama D, Ohnishi E, Suda W, Kurakazu M, Kiyoshima C, Hirakawa T, Miyata K, Yotsumoto F, Nabeshima K, Setoue T, Nagamitsu S, Hattori M, Hata K, Miyamoto S. Vaginal microbiome as a tool for prediction of chorioamnionitis in preterm labor: a pilot study. Sci Rep 2021; 11:18971. [PMID: 34556804 PMCID: PMC8460623 DOI: 10.1038/s41598-021-98587-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Accepted: 09/08/2021] [Indexed: 11/17/2022] Open
Abstract
Intra-amniotic infection (IAI) is a major cause of preterm birth with a poor perinatal prognosis. We aimed to determine whether analyzing vaginal microbiota can evaluate the risk of chorioamnionitis (CAM) in preterm labor cases. Vaginal discharge samples were collected from 83 pregnant women admitted for preterm labor. Based on Blanc's classification, the participants were divided into CAM (stage ≥ II; n = 46) and non-CAM (stage ≤ I; n = 37) groups. The 16S rDNA amplicons (V1-V2) from vaginal samples were sequenced and analyzed. Using a random forest algorithm, the bacterial species associated with CAM were identified, and a predictive CAM (PCAM) scoring method was developed. The α diversity was significantly higher in the CAM than in the non-CAM group (P < 0.001). The area under the curve was 0.849 (95% confidence interval 0.765-0.934) using the PCAM score. Among patients at < 35 weeks of gestation, the PCAM group (n = 22) had a significantly shorter extended gestational period than the non-PCAM group (n = 25; P = 0.022). Multivariate analysis revealed a significant difference in the frequency of developmental disorders in 3-year-old infants (PCAM, 28%, non-PCAM, 4%; P = 0.022). Analyzing vaginal microbiota can evaluate the risk of IAI. Future studies should establish appropriate interventions for IAI high-risk patients to improve perinatal prognosis.
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Affiliation(s)
- Daichi Urushiyama
- Department of Obstetrics and Gynecology, Faculty of Medicine, Fukuoka University, 7-45-1 Nanakuma, Jonan-ku, Fukuoka, 814-0180, Japan
| | - Eriko Ohnishi
- Department of Maternal-Fetal Biology, National Research Institute for Child Health and Development, Tokyo, 157-8535, Japan
| | - Wataru Suda
- Laboratory for Microbiome Sciences, RIKEN Center for Integrative Medical Sciences, Yokohama, 230-0045, Japan
| | - Masamitsu Kurakazu
- Department of Obstetrics and Gynecology, Faculty of Medicine, Fukuoka University, 7-45-1 Nanakuma, Jonan-ku, Fukuoka, 814-0180, Japan
| | - Chihiro Kiyoshima
- Department of Obstetrics and Gynecology, Faculty of Medicine, Fukuoka University, 7-45-1 Nanakuma, Jonan-ku, Fukuoka, 814-0180, Japan
| | - Toyofumi Hirakawa
- Department of Obstetrics and Gynecology, Faculty of Medicine, Fukuoka University, 7-45-1 Nanakuma, Jonan-ku, Fukuoka, 814-0180, Japan
| | - Kohei Miyata
- Department of Obstetrics and Gynecology, Faculty of Medicine, Fukuoka University, 7-45-1 Nanakuma, Jonan-ku, Fukuoka, 814-0180, Japan
| | - Fusanori Yotsumoto
- Department of Obstetrics and Gynecology, Faculty of Medicine, Fukuoka University, 7-45-1 Nanakuma, Jonan-ku, Fukuoka, 814-0180, Japan
| | - Kazuki Nabeshima
- Department of Pathology, Fukuoka University School of Medicine and Hospital, Fukuoka, 814-0180, Japan
| | - Takashi Setoue
- Center for Maternal, Fetal and Neonatal Medicine, Fukuoka University Hospital, Fukuoka, 814-0180, Japan
| | - Shinichiro Nagamitsu
- Department of Pediatrics, School of Medicine, Fukuoka University, Fukuoka, 814-0180, Japan
| | - Masahira Hattori
- Laboratory for Microbiome Sciences, RIKEN Center for Integrative Medical Sciences, Yokohama, 230-0045, Japan
- Graduate School of Advanced Science and Engineering, Waseda University, Tokyo, 169-8555, Japan
| | - Kenichiro Hata
- Department of Maternal-Fetal Biology, National Research Institute for Child Health and Development, Tokyo, 157-8535, Japan
| | - Shingo Miyamoto
- Department of Obstetrics and Gynecology, Faculty of Medicine, Fukuoka University, 7-45-1 Nanakuma, Jonan-ku, Fukuoka, 814-0180, Japan.
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Placental pathology and intraventricular hemorrhage in preterm and small for gestational age infants. J Perinatol 2021; 41:843-849. [PMID: 33649433 DOI: 10.1038/s41372-021-00954-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 12/04/2020] [Accepted: 01/21/2021] [Indexed: 01/31/2023]
Abstract
OBJECTIVE The aim of this study was to examine the relationship between chorioamnionitis and vascular malperfusion on placental pathology and intraventricular hemorrhage (IVH) in premature and small for gestational age (SGA) infants. STUDY DESIGN A retrospective analysis of 263 infants ≤34 weeks gestation or ≤1800 g and their mothers was conducted by chart review for placental pathology and clinical data from 2014 to 2018. Unadjusted and adjusted odds ratios (OR) for the association of placental pathology with IVH were calculated. RESULT Unadjusted OR showed an association between acute chorioamnionitis and IVH, but logistic regression analysis showed a non-significant adjusted OR between acute or chronic chorioamnionitis with IVH. Maternal vascular malperfusion was significantly associated with increased IVH when controlling for confounders. CONCLUSION Placental maternal vascular malperfusion is associated with the development of IVH in premature and SGA infants when controlling for other confounders.
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Story L, Davidson A, Patkee P, Fleiss B, Kyriakopoulou V, Colford K, Sankaran S, Seed P, Jones A, Hutter J, Shennan A, Rutherford M. Brain volumetry in fetuses that deliver very preterm: An MRI pilot study. NEUROIMAGE-CLINICAL 2021; 30:102650. [PMID: 33838546 PMCID: PMC8045030 DOI: 10.1016/j.nicl.2021.102650] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Revised: 03/10/2021] [Accepted: 03/26/2021] [Indexed: 11/17/2022]
Abstract
Fetuses that subsequently deliver very preterm have a reduction in cortical and extra cerebrospinal fluid volumes. If such alterations commence antenatally this suggests a role for earlier administration of neuroprotective agents.
Background Infants born preterm are at increased risk of neurological complications resulting in significant morbidity and mortality. The exact mechanism and the impact of antenatal factors has not been fully elucidated, although antenatal infection/inflammation has been implicated in both the aetiology of preterm birth and subsequent neurological sequelae. It is therefore hypothesized that processes driving preterm birth are affecting brain development in utero. This study aims to compare MRI derived regional brain volumes in fetuses that deliver < 32 weeks with fetuses that subsequently deliver at term. Methods Women at high risk of preterm birth, with gestation 19.4–32 weeks were recruited prospectively. A control group was obtained from existing study datasets. Fetal MRI was performed on a 1.5 T or 3 T MRI scanner: T2-weighted images were obtained of the fetal brain. 3D brain volumetric datsets were produced using slice to volume reconstruction and regional segmentations were produced using multi-atlas approaches for supratentorial brain tissue, lateral ventricles, cerebellum cerebral cortex and extra-cerebrospinal fluid (eCSF). Statistical comparison of control and high-risk for preterm delivery fetuses was performed by creating normal ranges for each parameter from the control datasets and then calculating gestation adjusted z scores. Groups were compared using t-tests. Results Fetal image datasets from 24 pregnancies with delivery < 32 weeks and 87 control pregnancies that delivered > 37 weeks were included. Median gestation at MRI of the preterm group was 26.8 weeks (range 19.4–31.4) and control group 26.2 weeks (range 21.7–31.9). No difference was found in supra-tentorial brain volume, ventricular volume or cerebellar volume but the eCSF and cerebral cortex volumes were smaller in fetuses that delivered preterm (p < 0.001 in both cases). Conclusion Fetuses that deliver preterm have a reduction in cortical and eCSF volumes. This is a novel finding and needs further investigation. If alterations in brain development are commencing antenatally in fetuses that subsequently deliver preterm, this may present a window for in utero therapy in the future.
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Affiliation(s)
- Lisa Story
- Department of Women and Children's Health, King's College London, UK.
| | - Alice Davidson
- Centre for the Developing Brain, King's College London, London, UK
| | - Prachi Patkee
- Centre for the Developing Brain, King's College London, London, UK
| | - Bobbi Fleiss
- Centre for the Developing Brain, King's College London, London, UK; School of Health and Biomedical Sciences, RMIT University, Bundoora 3083, VIC, Australia; Université de Paris, NeuroDiderot, Inserm, F-75019 Paris, France
| | | | - Kathleen Colford
- Centre for the Developing Brain, King's College London, London, UK; Centre for Medical Engineering, King's College London, London, UK
| | | | - Paul Seed
- Department of Women and Children's Health, King's College London, UK
| | - Alice Jones
- Centre for the Developing Brain, King's College London, London, UK; Queen Mary University Medical School, UK
| | - Jana Hutter
- Centre for the Developing Brain, King's College London, London, UK; School of Health and Biomedical Sciences, RMIT University, Bundoora 3083, VIC, Australia
| | - Andrew Shennan
- Department of Women and Children's Health, King's College London, UK
| | - Mary Rutherford
- Centre for the Developing Brain, King's College London, London, UK
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Zaghloul N, Kurepa D, Bader MY, Nagy N, Ahmed MN. Prophylactic inhibition of NF-κB expression in microglia leads to attenuation of hypoxic ischemic injury of the immature brain. J Neuroinflammation 2020; 17:365. [PMID: 33261624 PMCID: PMC7709340 DOI: 10.1186/s12974-020-02031-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Accepted: 11/10/2020] [Indexed: 11/29/2022] Open
Abstract
Background Periventricular leukomalacia (PVL), a devastating brain injury affecting premature infants, is the most common cause of cerebral palsy. PVL is caused by hypoxia ischemia (HI) and is characterized by white matter necrotic lesions, microglial activation, upregulation of NF-κB, and neuronal death. The microglia is the main cell involved in PVL pathogenesis. The goal of this study was to investigate the role of microglial NF-κB activity and its prophylactic inhibition in a neonate mouse model of HI. Methods Transgenic mice with specific knockout NF-κB in microglia and colony stimulating factor 1 receptor Cre with floxed IKKβ (CSF-1R Cre + IKKβflox/wt ) were used. Postnatal day 5 (P5) mice underwent sham or bilateral temporary carotid artery ligation followed by hypoxia. After HI insult, inflammatory cytokines, volumetric MRI, histopathology, and immunohistochemistry for oligodendroglia and microglial activation markers were analyzed. Long-term neurobehavioral assessment, including grip strength, rotarod, and open field testing, was performed at P60. Results We demonstrate that selective inhibition of NF-κB in microglia decreases HI-induced brain injury by decreasing microglial activation, proinflammatory cytokines, and nitrative stress. Rescue of oligodendroglia is evidenced by immunohistochemistry, decreased ventriculomegaly on MRI, and histopathology. This selective inhibition leads to attenuation of paresis, incoordination, and improved grip strength, gait, and locomotion. Conclusion We conclude that NF-κb activation in microglia plays a major role in the pathogenesis of hypoxic ischemic injury of the immature brain, and its prophylactic inhibition offers significant neuroprotection. Using a specific inhibitor of microglial NF-κB may offer a new prophylactic or therapeutic alternative in preterm infants affected by HI and possibly other neurological diseases in which microglial activation plays a role.
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Affiliation(s)
- Nahla Zaghloul
- Department of Pediatrics, Division of Neonatology, University of Arizona, 1501 N. Campbell Avenue, Tucson, AZ, USA.
| | - Dalibor Kurepa
- Department of Pediatrics, Division of Neonatology, Feinstein Institute for Medical Research, Manhasset, NY, USA
| | - Mohammad Y Bader
- Department of Pediatrics, Division of Neonatology, University of Arizona, 1501 N. Campbell Avenue, Tucson, AZ, USA
| | - Nadia Nagy
- Department of Pediatrics, Division of Neonatology, University of Arizona, 1501 N. Campbell Avenue, Tucson, AZ, USA
| | - Mohamed N Ahmed
- Department of Pediatrics, Division of Neonatology, University of Arizona, 1501 N. Campbell Avenue, Tucson, AZ, USA
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11
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Gomez-Lopez N, Romero R, Varrey A, Leng Y, Miller D, Done B, Xu Y, Bhatti G, Motomura K, Gershater M, Pique-Regi R, Tarca AL. RNA Sequencing Reveals Diverse Functions of Amniotic Fluid Neutrophils and Monocytes/Macrophages in Intra-Amniotic Infection. J Innate Immun 2020; 13:63-82. [PMID: 33152737 DOI: 10.1159/000509718] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 06/25/2020] [Indexed: 12/17/2022] Open
Abstract
Intra-amniotic infection, the invasion of microbes into the amniotic cavity resulting in inflammation, is a clinical condition that can lead to adverse pregnancy outcomes for the mother and fetus as well as severe long-term neonatal morbidities. Despite much research focused on the consequences of intra-amniotic infection, there remains little knowledge about the innate immune cells that respond to invading microbes. We performed RNA-seq of sorted amniotic fluid neutrophils and monocytes/macrophages from women with intra-amniotic infection to determine the transcriptomic differences between these innate immune cells. Further, we sought to identify specific transcriptomic pathways that were significantly altered by the maternal or fetal origin of amniotic fluid neutrophils and monocytes/macrophages, the presence of a severe fetal inflammatory response, and pregnancy outcome (i.e., preterm or term delivery). We show that significant transcriptomic differences exist between amniotic fluid neutrophils and monocytes/macrophages from women with intra-amniotic infection, indicating the distinct roles these cells play. The transcriptome of amniotic fluid immune cells varies based on their maternal or fetal origin, and the significant transcriptomic differences between fetal and maternal monocytes/macrophages imply that those of fetal origin exhibit impaired functions. Notably, transcriptomic changes in amniotic fluid monocytes/macrophages suggest that these immune cells collaborate with neutrophils in the trafficking of fetal leukocytes throughout the umbilical cord (i.e., funisitis). Finally, amniotic fluid neutrophils and monocytes/macrophages from preterm deliveries display enhanced transcriptional activity compared to those from term deliveries, highlighting the protective role of these cells during this vulnerable period. Collectively, these findings demonstrate the underlying complexity of local innate immune responses in women with intra-amniotic infection and provide new insights into the functions of neutrophils and monocytes/macrophages in the amniotic cavity.
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Affiliation(s)
- Nardhy Gomez-Lopez
- Perinatology Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, US Department of Health and Human Services (NICHD/NIH/DHHS), Bethesda, Michigan, USA, .,Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, Michigan, USA, .,Department of Biochemistry, Microbiology and Immunology, Wayne State University School of Medicine, Detroit, Michigan, USA,
| | - Roberto Romero
- Perinatology Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, US Department of Health and Human Services (NICHD/NIH/DHHS), Bethesda, Michigan, USA.,Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, Michigan, USA.,Department of Epidemiology and Biostatistics, Michigan State University, East Lansing, Michigan, USA.,Center for Molecular Medicine and Genetics, Wayne State University, Detroit, Michigan, USA.,Detroit Medical Center, Detroit, Michigan, USA.,Department of Obstetrics and Gynecology, Florida International University, Miami, Florida, USA
| | - Aneesha Varrey
- Perinatology Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, US Department of Health and Human Services (NICHD/NIH/DHHS), Bethesda, Michigan, USA.,Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Yaozhu Leng
- Perinatology Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, US Department of Health and Human Services (NICHD/NIH/DHHS), Bethesda, Michigan, USA.,Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Derek Miller
- Perinatology Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, US Department of Health and Human Services (NICHD/NIH/DHHS), Bethesda, Michigan, USA.,Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Bogdan Done
- Perinatology Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, US Department of Health and Human Services (NICHD/NIH/DHHS), Bethesda, Michigan, USA.,Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Yi Xu
- Perinatology Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, US Department of Health and Human Services (NICHD/NIH/DHHS), Bethesda, Michigan, USA.,Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Gaurav Bhatti
- Perinatology Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, US Department of Health and Human Services (NICHD/NIH/DHHS), Bethesda, Michigan, USA.,Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Kenichiro Motomura
- Perinatology Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, US Department of Health and Human Services (NICHD/NIH/DHHS), Bethesda, Michigan, USA.,Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Meyer Gershater
- Perinatology Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, US Department of Health and Human Services (NICHD/NIH/DHHS), Bethesda, Michigan, USA.,Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Roger Pique-Regi
- Perinatology Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, US Department of Health and Human Services (NICHD/NIH/DHHS), Bethesda, Michigan, USA.,Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, Michigan, USA.,Center for Molecular Medicine and Genetics, Wayne State University, Detroit, Michigan, USA
| | - Adi L Tarca
- Perinatology Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, US Department of Health and Human Services (NICHD/NIH/DHHS), Bethesda, Michigan, USA.,Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, Michigan, USA.,Department of Computer Science, Wayne State University College of Engineering, Detroit, Michigan, USA
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12
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Villamor-Martinez E, Lubach GA, Rahim OM, Degraeuwe P, Zimmermann LJ, Kramer BW, Villamor E. Association of Histological and Clinical Chorioamnionitis With Neonatal Sepsis Among Preterm Infants: A Systematic Review, Meta-Analysis, and Meta-Regression. Front Immunol 2020; 11:972. [PMID: 32582153 PMCID: PMC7289970 DOI: 10.3389/fimmu.2020.00972] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Accepted: 04/24/2020] [Indexed: 12/13/2022] Open
Abstract
Chorioamnionitis (CA) is considered a key risk factor for very preterm birth and for developing early onset sepsis (EOS) in preterm infants, but recent data suggest that CA might be protective against late onset sepsis (LOS). We performed a systematic review and meta-analysis of studies exploring the association between CA and sepsis. A comprehensive literature search was performed in PubMed/MEDLINE and EMBASE, from their inception to December 1, 2018. A random-effects model was used to calculate odds ratios (OR) and 95% confidence intervals (CI). Sources of heterogeneity were analyzed by subgroup and meta-regression analyses. The following categories of sepsis were analyzed: EOS, LOS, unspecified onset sepsis (UOS), culture-proven, and clinical sepsis. CA was subdivided into clinical and histological chorioamnionitis. Funisitis was also analyzed. We found 3,768 potentially relevant studies, of which 107 met the inclusion criteria (387,321 infants; 44,414 cases of CA). Meta-analysis showed an association between any CA and any EOS (OR 4.29, CI 3.63-5.06), any LOS (OR 1.29, CI 1.11-1.54), and any UOS (OR 1.59, CI 1.11-1.54). Subgroup analysis showed that CA was associated with culture-proven EOS (OR 4.69, CI 3.91-5.56), clinical EOS (OR 3.58, CI 1.90-6.76), and culture-proven LOS (OR 1.31, CI 1.12-1.53), but not with clinical LOS (OR 1.52, CI 0.78-2.96). The presence of funisitis did not increase the risk of either EOS or LOS when compared with CA without funisitis. CA-exposed infants had lower gestational age (-1.11 weeks, CI -1.37 to -0.84) than the infants not exposed to CA. Meta-regression analysis showed that the lower gestational age of the CA group correlated with the association between CA and LOS but not with the association between CA and EOS. In conclusion, our data suggest that the positive association between chorioamnionitis and LOS may be modulated by the effect of chorioamnionitis on gestational age.
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Affiliation(s)
| | | | | | | | | | | | - Eduardo Villamor
- Department of Pediatrics, Maastricht University Medical Center (MUMC+), School for Oncology and Developmental Biology (GROW), Maastricht, Netherlands
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13
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Xing L, Wang G, Chen R, Ren J, Qian J, Huang Y. Is chorioamnionitis associated with neurodevelopmental outcomes in preterm infants? A systematic review and meta-analysis following PRISMA. Medicine (Baltimore) 2019; 98:e18229. [PMID: 31852083 PMCID: PMC6922490 DOI: 10.1097/md.0000000000018229] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND The relationships between chorioamnionitis (CA) and neurodevelopmental outcomes in preterm infants remain controversial. The meta-analysis aims to evaluate the associations between CA and neurodevelopmental deficits in preterm infants. METHODS All studies exploring the associations between CA and neurodevelopmental deficits in preterm infants were retrieved from the following databases: PubMed, Embase, OVID, EBSCO, ProQuest, CDSR, and CENTRAL. The NOS was used to evaluate the quality of the studies, RevMan was adopted to analyze the data. RESULTS Twelve studies involving 4267 preterm infants were included. The ORs across studies was 0.95 (P = .77, I = 51%) for cognitive deficits, 1.09 (P = .44, I = 10%) for psychomotor deficits, 1.21 (P = .08, I = 25%) for language deficits, 2.34 (P = .02, I = 0%) for performance intelligence quotient impairment and 2.81 (P = .03, I = 0%) for verbal intelligence quotient impairment. Subgroup analyses based on the severity of cognitive deficits indicated that CA might be correlated with severe cognitive deficits (P = .01, I = 0%) but not with mild cognitive deficits (P = .40, I = 19%). In terms of the CA category, clinical CA may be related to overall psychomotor deficits (P = .01, I = 25%) and overall language deficits (P < .00001, I = 23%) other than histological CA. CONCLUSION In preterm infants, CA might be a risk factor for performance and verbal intelligence quotient impairment and severe cognitive deficits, and clinical CA might be a risk factor for overall psychomotor and language deficits.
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Affiliation(s)
| | - Guoyu Wang
- Delivery Room, West China Second University Hospital, Sichuan University, Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education
| | - Ruiqi Chen
- Department of Neurosurgery, West China Hospital of Sichuan University
| | - Jianhua Ren
- Department of Nursing, West China Second University Hospital, Sichuan University, Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education
| | - Jiahui Qian
- West China School of Public Health, Sichuan University, Chengdu, Sichuan Province, China
| | - Yan Huang
- Department of Nursing, West China Second University Hospital, Sichuan University, Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education
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14
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Romero R, Gomez-Lopez N, Winters AD, Jung E, Shaman M, Bieda J, Panaitescu B, Pacora P, Erez O, Greenberg JM, Ahmad MM, Hsu CD, Theis KR. Evidence that intra-amniotic infections are often the result of an ascending invasion - a molecular microbiological study. J Perinat Med 2019; 47:915-931. [PMID: 31693497 PMCID: PMC7147941 DOI: 10.1515/jpm-2019-0297] [Citation(s) in RCA: 96] [Impact Index Per Article: 19.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Accepted: 08/18/2019] [Indexed: 12/15/2022]
Abstract
Background Microbial invasion of the amniotic cavity resulting in intra-amniotic infection is associated with obstetrical complications such as preterm labor with intact or ruptured membranes, cervical insufficiency, as well as clinical and histological chorioamnionitis. The most widely accepted pathway for intra-amniotic infection is the ascension of microorganisms from the lower genital tract. However, hematogenous dissemination of microorganisms from the oral cavity or intestine, retrograde seeding from the peritoneal cavity through the fallopian tubes, and introduction through invasive medical procedures have also been suggested as potential pathways for intra-amniotic infection. The primary reason that an ascending pathway is viewed as most common is that the microorganisms most often detected in the amniotic fluid are those that are typical inhabitants of the vagina. However, thus far, no studies have shown that microorganisms in the amniotic cavity are simultaneously present in the vagina of the woman from which they were isolated. The objective of the study was to determine the frequency with which microorganisms isolated from women with intra-amniotic infection are also present in the lower genital tract. Methods This was a cross-sectional study of women with intra-amniotic infection with intact membranes. Intra-amniotic infection was defined as a positive culture and elevated concentrations of interleukin-6 (IL-6) (>2.6 ng/mL) in amniotic fluid and/or acute histologic chorioamnionitis and funisitis. Microorganisms isolated from bacterial cultures of amniotic fluid were taxonomically identified through matrix-assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF) and 16S ribosomal RNA (rRNA) gene sequencing. Vaginal swabs were obtained at the time of amniocentesis for the identification of microorganisms in the lower genital tract. The overall bacterial profiles of amniotic fluids and vaginal swabs were characterized through 16S rRNA gene sequencing. The bacterial profiles of vaginal swabs were interrogated for the presence of bacteria cultured from amniotic fluid and for the presence of prominent (>1% average relative abundance) operational taxonomic units (OTUs) within the overall 16S rRNA gene bacterial profiles of amniotic fluid. Results (1) A total of 75% (6/8) of women had bacteria cultured from their amniotic fluid that are typical residents of the vaginal ecosystem. (2) A total of 62.5% (5/8) of women with bacteria cultured from their amniotic fluid also had these bacteria present in their vagina. (3) The microorganisms cultured from amniotic fluid and also detected in the vagina were Ureaplasma urealyticum, Escherichia coli, and Streptococcus agalactiae. (4) 16S rRNA gene sequencing revealed that the amniotic fluid of women with intra-amniotic infection had bacterial profiles dominated by Sneathia, Ureaplasma, Prevotella, Lactobacillus, Escherichia, Gardnerella, Peptostreptococcus, Peptoniphilus, and Streptococcus, many of which had not been cultured from the amniotic fluid samples. (5) Seventy percent (7/10) of the prominent (>1% average relative abundance) OTUs found in amniotic fluid were also prominent in the vagina. Conclusion The majority of women with intra-amniotic infection had bacteria cultured from their amniotic fluid that were typical vaginal commensals, and these bacteria were detected within the vagina at the time of amniocentesis. Molecular microbiological interrogation of amniotic fluid from women with intra-amniotic infection revealed that the bacterial profiles of amniotic fluid were largely consistent with those of the vagina. These findings indicate that ascension from the lower genital tract is the primary pathway for intra-amniotic infection.
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Affiliation(s)
- Roberto Romero
- Perinatology Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, U.S. Department of Health and Human Services, Bethesda, MD, and Detroit, MI, USA
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI, USA
- Department of Epidemiology and Biostatistics, Michigan State University, East Lansing, MI, USA
- Center for Molecular Medicine and Genetics, Wayne State University, Detroit, MI, USA
- Detroit Medical Center, Detroit, MI, USA
- Department of Obstetrics and Gynecology, Florida International University, Miami, FL, USA
| | - Nardhy Gomez-Lopez
- Perinatology Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, U.S. Department of Health and Human Services, Bethesda, MD, and Detroit, MI, USA
- Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, MI, USA
- Department of Biochemistry, Microbiology and Immunology, Wayne State University School of Medicine, Detroit, MI, USA
- Perinatal Research Initiative in Maternal, Perinatal and Child Health, Wayne State University School of Medicine, Detroit, MI, USA
| | - Andrew D. Winters
- Perinatology Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, U.S. Department of Health and Human Services, Bethesda, MD, and Detroit, MI, USA
- Department of Biochemistry, Microbiology and Immunology, Wayne State University School of Medicine, Detroit, MI, USA
| | - Eunjung Jung
- Perinatology Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, U.S. Department of Health and Human Services, Bethesda, MD, and Detroit, MI, USA
- Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, MI, USA
| | - Majid Shaman
- Perinatology Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, U.S. Department of Health and Human Services, Bethesda, MD, and Detroit, MI, USA
- Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, MI, USA
| | - Janine Bieda
- Perinatology Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, U.S. Department of Health and Human Services, Bethesda, MD, and Detroit, MI, USA
- Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, MI, USA
| | - Bogdan Panaitescu
- Perinatology Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, U.S. Department of Health and Human Services, Bethesda, MD, and Detroit, MI, USA
- Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, MI, USA
| | - Percy Pacora
- Perinatology Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, U.S. Department of Health and Human Services, Bethesda, MD, and Detroit, MI, USA
- Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, MI, USA
| | - Offer Erez
- Perinatology Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, U.S. Department of Health and Human Services, Bethesda, MD, and Detroit, MI, USA
- Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, MI, USA
- Maternity Department “D,” Division of Obstetrics and Gynecology, Soroka University Medical Center School of Medicine, Faculty of Health Sciences, Ben Gurion University of the Negev, Beer-Sheva, Israel
| | - Jonathan M. Greenberg
- Department of Biochemistry, Microbiology and Immunology, Wayne State University School of Medicine, Detroit, MI, USA
| | - Madison M. Ahmad
- Department of Biochemistry, Microbiology and Immunology, Wayne State University School of Medicine, Detroit, MI, USA
| | - Chaur-Dong Hsu
- Perinatology Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, U.S. Department of Health and Human Services, Bethesda, MD, and Detroit, MI, USA
- Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, MI, USA
- Perinatal Research Initiative in Maternal, Perinatal and Child Health, Wayne State University School of Medicine, Detroit, MI, USA
- Department of Physiology, Wayne State University School of Medicine, Detroit, MI, USA
| | - Kevin R. Theis
- Perinatology Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, U.S. Department of Health and Human Services, Bethesda, MD, and Detroit, MI, USA
- Department of Biochemistry, Microbiology and Immunology, Wayne State University School of Medicine, Detroit, MI, USA
- Perinatal Research Initiative in Maternal, Perinatal and Child Health, Wayne State University School of Medicine, Detroit, MI, USA
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15
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García González E, Izquierdo Renau M, Aldecoa-Bilbao V, Vergès Castells A, Rovira Zurriaga C, Iglesias Platas I. Impact of histological chorioamnionitis on postnatal growth in very-low birth weight infants. J Matern Fetal Neonatal Med 2019; 34:1780-1785. [PMID: 31370701 DOI: 10.1080/14767058.2019.1648423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND Postnatal growth restriction remains one of the most common problems of very preterm infants (VPI). Chorioamnionitis is a frequent cause of prematurity. Both have been related to worse postnatal outcomes. OBJECTIVES To evaluate the influence of histological chorioamnionitis (CA) on postnatal growth in very premature infants. METHODS Retrospective one-to-one matched cohort study assessing growth in infants born at or below 32.0 weeks gestation from mothers for whom histological examination of the placenta was available. Newborns with histological CA were matched and compared with those without it. Postnatal growth was recorded at admission, 14 days of life, 28 days of life and 36 weeks postmenstrual age (PMA). Nutritional support and clinical outcomes were used as covariables. RESULTS Eighty-eight patients were included: 44 with fetal or/and maternal placental inflammation, and 44 without histological CA (41% with vasculopathy findings and 59% without). Baseline characteristics were similar between the groups. Change in weight z-scores at 14 days of life, 28 days of life, 36 weeks PMA or at discharge were similar in both groups, with a steady fall and no signs of catch-up. No differences were found in enteral and parenteral nutritional intakes between groups. CONCLUSIONS Histological CA did not affect postnatal growth of very preterm infants after matching for birth weight z-scores with non-CA newborns.
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Affiliation(s)
- Elsa García González
- Neonatology Department, Hospital Sant Joan de Déu, BCNatal, Institut de Reçerca Sant Joan de Déu, Barcelona, Spain
| | - Montserrat Izquierdo Renau
- Neonatology Department, Hospital Sant Joan de Déu, BCNatal, Institut de Reçerca Sant Joan de Déu, Barcelona, Spain
| | | | - Alba Vergès Castells
- Neonatology Department, Hospital Sant Joan de Déu, BCNatal, Institut de Reçerca Sant Joan de Déu, Barcelona, Spain
| | - Carlota Rovira Zurriaga
- Neonatology Department, Hospital Sant Joan de Déu, BCNatal, Institut de Reçerca Sant Joan de Déu, Barcelona, Spain
| | - Isabel Iglesias Platas
- Neonatology Department, Hospital Sant Joan de Déu, BCNatal, Institut de Reçerca Sant Joan de Déu, Barcelona, Spain
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16
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Sung JH, Choi SJ, Oh SY, Roh CR. Should the diagnostic criteria for suspected clinical chorioamnionitis be changed? J Matern Fetal Neonatal Med 2019; 34:824-833. [PMID: 31084245 DOI: 10.1080/14767058.2019.1618822] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Purpose of review: The criteria for the diagnosis of intra-amniotic infection (IAI) were derived from a study of women at term in labor but is currently used as the main diagnostic tool for clinical chorioamnionitis. Regarding the inconsistent usage of the term, the diagnostic utility of clinical chorioamnionitis needs to be revisited. In this review, we addressed the critical issues on why the diagnostic criteria of suspected clinical chorioamnionitis should be changed.Recent findings: Overall, the accuracy of clinical chorioamnionitis to detect intra-amniotic infection (IAI) is not high, around 50%. The accuracy of each diagnostic criteria to diagnose IAI is, for example, 51.1% with maternal tachycardia, 57.8% with fetal tachycardia, and 55.6% with maternal leukocytosis. However, it needs to be reminded that these diagnostic performances had been obtained from term pregnancies but not from preterm pregnancies. Since there is a difference between clinical chorioamnionitis and histologic chorioamnionitis or even IAI, the diagnostic criteria of clinical chorioamnionitis would be ideal if it could directly predict the development of neonatal infectious outcomes. In fact, multiple definitions of clinical chorioamnionitis either in more lenient or stringent manner are currently used, which is responsible for inconsistent association of clinical chorioamnionitis with long-term neonatal outcomes. Whereas the diagnosis of clinical chorioamnionitis in preterm is followed by expeditious delivery, the diagnosis of clinical chorioamnionitis at term pregnancy is usually conducted in laboring women and requires additional neonatal evaluation for sepsis, which suggests different implications of clinical chorioamnionitis in preterm and term pregnancy.Summary: Current diagnostic criteria of clinical chorioamnionitis should be revised, specifically in terms of sensitivity in preterm pregnancy and specificity in term pregnancy.
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Affiliation(s)
- Ji-Hee Sung
- Department of Obstetrics and Gynecology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Suk-Joo Choi
- Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Soo-Young Oh
- Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Cheong-Rae Roh
- Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Freud A, Wainstock T, Sheiner E, Beloosesky R, Fischer L, Landau D, Walfisch A. Maternal chorioamnionitis & long term neurological morbidity in the offspring. Eur J Paediatr Neurol 2019; 23:484-490. [PMID: 31005407 DOI: 10.1016/j.ejpn.2019.03.005] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2018] [Revised: 03/18/2019] [Accepted: 03/19/2019] [Indexed: 11/16/2022]
Abstract
BACKGROUND Chorioamnionitis is a common and potentially devastating complication of pregnancy associated with maternal and perinatal adverse outcomes. OBJECTIVE To evaluate a possible association between maternal chorioamnionitis and long-term pediatric neurological morbidity. STUDY DESIGN A population-based retrospective cohort analysis was performed comparing the risk of long-term neurological morbidity. Pediatric neurological morbidity evaluated included hospitalizations with neurological morbidity. Kaplan-Meier survival curves were constructed to compare the cumulative neurological morbidity and a Cox regression model was used to control for confounders. RESULTS 238 622 newborns were included. Of them, 0.5% were born to mothers with chorioamnionitis. 3.1% offspring were hospitalized with a neurological condition. Total neurological morbidity was not significantly more common in the chorioamnionitis group (3.8% vs. 3.1% respectively, OR 1.23, 95% CI 0.9-1.6, p = 0.147). However, a significant and independent association was noted between maternal chorioamnionitis and cerebral palsy. (0.5% vs. 0.1%, OR 5.77, 95% CI 2.5-13.0, p = 0.001). In a Cox proportional hazards model, controlling for preterm delivery, birthweight, maternal factors and mode of delivery the association between chorioamnionitis and cerebral palsy remained significant (adjusted HR = 2.78, 95% CI 1.20-6.43, P = 0.016). CONCLUSION Maternal chorioamnionitis is associated with cerebral palsy in the offspring, independently of other birth circumstances such as preterm delivery and birthweight.
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Affiliation(s)
- Amir Freud
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
| | - Tamar Wainstock
- The Department of Public Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Eyal Sheiner
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Ron Beloosesky
- Obstetrics and Gynecology Ultrasound Unit in the Department of Obstetrics and Gynecology at Rambam Health Care Campus, Israel
| | - Laura Fischer
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Daniella Landau
- Department of Pediatrics, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Asnat Walfisch
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel
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Placental Pathology and Neuroimaging Correlates in Neonates with Congenital Heart Disease. Sci Rep 2019; 9:4137. [PMID: 30858514 PMCID: PMC6411739 DOI: 10.1038/s41598-019-40894-y] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Accepted: 02/19/2019] [Indexed: 01/20/2023] Open
Abstract
Congenital heart disease (CHD) is an independent risk factor for brain injury, including stroke, and poor neurodevelopmental outcomes, and placental abnormalities may represent an additional risk factor for brain injury in neonates. The incidence and scope of placental pathology and relationship to fetal brain abnormalities in pregnancies complicated by fetal CHD has not been explored to our knowledge. In order to determine the prevalence of placental pathology findings and whether placental findings are associated with postnatal brain injury in pregnancies complicated by fetal CHD, we reviewed placental pathology reports for 51 pregnancies complicated by CHD and scored available postnatal, pre-operative brain MRI for brain pathology. Overall, 57% of CHD infants had abnormal placental pathology. Pregnancies complicated by CHD with aortic obstruction (AO) were significantly more likely than those with no obstruction to have abnormal placental pathology (79% vs. 44%). There was a trend toward more severe brain lesions amongst patients with brain lesions and placental abnormality (55% moderate/severe) compared to those without placental abnormality (11% moderate/severe). These data suggest that placental abnormalities are common in CHD and may have a compounding effect on brain lesions in this high-risk population.
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Villamor-Martinez E, Cavallaro G, Raffaeli G, Mohammed Rahim OMM, Gulden S, Ghazi AMT, Mosca F, Degraeuwe P, Villamor E. Chorioamnionitis as a risk factor for retinopathy of prematurity: An updated systematic review and meta-analysis. PLoS One 2018; 13:e0205838. [PMID: 30332485 PMCID: PMC6192636 DOI: 10.1371/journal.pone.0205838] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Accepted: 10/02/2018] [Indexed: 12/23/2022] Open
Abstract
The role of chorioamnionitis (CA) in the development of retinopathy of prematurity (ROP) is difficult to establish, because CA-exposed and CA-unexposed infants frequently present different baseline characteristics. We performed an updated systematic review and meta-analysis of studies reporting on the association between CA and ROP. We searched PubMed and EMBASE for relevant articles. Studies were included if they examined preterm or very low birth weight (VLBW, <1500g) infants and reported primary data that could be used to measure the association between exposure to CA and the presence of ROP. Of 748 potentially relevant studies, 50 studies met the inclusion criteria (38,986 infants, 9,258 CA cases). Meta-analysis showed a significant positive association between CA and any stage ROP (odds ratio [OR] 1.39, 95% confidence interval [CI] 1.11 to 1.74). CA was also associated with severe (stage ≥3) ROP (OR 1.63, 95% CI 1.41 to 1.89). Exposure to funisitis was associated with a higher risk of ROP than exposure to CA in the absence of funisitis. Additional meta-analyses showed that infants exposed to CA had lower gestational age (GA) and lower birth weight (BW). Meta-regression showed that lower GA and BW in the CA-exposed group was significantly associated with a higher risk of ROP. Meta-analyses of studies with data adjusted for confounders could not find a significant association between CA and ROP. In conclusion, our study confirms that CA is a risk factor for developing ROP. However, part of the effects of CA on the pathogenesis of ROP may be mediated by the role of CA as an etiological factor for very preterm birth.
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Affiliation(s)
- Eduardo Villamor-Martinez
- Department of Pediatrics, Maastricht University Medical Center (MUMC+), School for Oncology and Developmental Biology (GROW), Maastricht, the Netherlands
| | - Giacomo Cavallaro
- Neonatal Intensive Care Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano, Milan, Italy
| | - Genny Raffaeli
- Neonatal Intensive Care Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano, Milan, Italy
| | - Owais M. M. Mohammed Rahim
- Department of Pediatrics, Maastricht University Medical Center (MUMC+), School for Oncology and Developmental Biology (GROW), Maastricht, the Netherlands
| | - Silvia Gulden
- Neonatal Intensive Care Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano, Milan, Italy
| | - Amro M. T. Ghazi
- Department of Pediatrics, Maastricht University Medical Center (MUMC+), School for Oncology and Developmental Biology (GROW), Maastricht, the Netherlands
| | - Fabio Mosca
- Neonatal Intensive Care Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano, Milan, Italy
| | - Pieter Degraeuwe
- Department of Pediatrics, Maastricht University Medical Center (MUMC+), School for Oncology and Developmental Biology (GROW), Maastricht, the Netherlands
| | - Eduardo Villamor
- Department of Pediatrics, Maastricht University Medical Center (MUMC+), School for Oncology and Developmental Biology (GROW), Maastricht, the Netherlands
- * E-mail:
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Villamor-Martinez E, Fumagalli M, Mohammed Rahim O, Passera S, Cavallaro G, Degraeuwe P, Mosca F, Villamor E. Chorioamnionitis Is a Risk Factor for Intraventricular Hemorrhage in Preterm Infants: A Systematic Review and Meta-Analysis. Front Physiol 2018; 9:1253. [PMID: 30271352 PMCID: PMC6142185 DOI: 10.3389/fphys.2018.01253] [Citation(s) in RCA: 50] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Accepted: 08/20/2018] [Indexed: 12/29/2022] Open
Abstract
Although chorioamnionitis (CA) is a well-known risk factor for white matter disease of prematurity, the association with intraventricular hemorrhage (IVH) is controversial and has not been yet systematically reviewed. We performed a systematic review and meta-analysis of studies exploring the association between CA and IVH. A comprehensive literature search was conducted using PubMed/MEDLINE and EMBASE, from their inception to 1 July 2017. Studies were included if they examined preterm infants and reported primary data that could be used to measure the association between exposure to CA and the presence of IVH. A random-effects model was used to calculate odds ratios (OR) and 95% confidence intervals (CI). We found 1,284 potentially relevant studies, of which 85 met the inclusion criteria (46,244 infants, 13,432 CA cases). Meta-analysis showed that CA exposure was significantly associated with all grades IVH (OR 1.88, 95% CI 1.61-2.19), with grades 1-2 IVH (OR 1.69, 95% CI 1.22-2.34), and with grades 3-4 IVH (OR 1.62, 95% CI 1.42-1.85). Both clinical and histological CA were associated with an increased risk for developing IVH in very preterm infants. In contrast, the presence of funisitis did not increase IVH risk when compared to CA in the absence of funisitis (OR 1.22, 95% CI 0.89-1.67). Further meta-analyses confirmed earlier findings that CA-exposed infants have significantly lower gestational age (GA; mean difference [MD] -1.20 weeks) and lower birth weight (BW; MD -55 g) than the infants not exposed to CA. However, meta-regression and subgroup analysis could not demonstrate an association between the lower GA and BW and the risk of IVH in the CA-exposed infants. In conclusion, our data show that CA is a risk factor for IVH, but also a risk factor for greater prematurity and more clinical instability. In contrast to other complications of prematurity, such as patent ductus arteriosus, retinopathy of prematurity, or bronchopulmonary dysplasia, the effect of CA on IVH appears to be independent of CA as causative factor for very preterm birth.
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Affiliation(s)
- Eduardo Villamor-Martinez
- Department of Pediatrics, School for Oncology and Developmental Biology (GROW), Maastricht University Medical Center, Maastricht, Netherlands
| | - Monica Fumagalli
- Neonatal Intensive Care Unit, Department of Clinical Sciences and Community Health, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano, Milan, Italy
| | - Owais Mohammed Rahim
- Department of Pediatrics, School for Oncology and Developmental Biology (GROW), Maastricht University Medical Center, Maastricht, Netherlands
| | - Sofia Passera
- Neonatal Intensive Care Unit, Department of Clinical Sciences and Community Health, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano, Milan, Italy
| | - Giacomo Cavallaro
- Neonatal Intensive Care Unit, Department of Clinical Sciences and Community Health, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano, Milan, Italy
| | - Pieter Degraeuwe
- Department of Pediatrics, School for Oncology and Developmental Biology (GROW), Maastricht University Medical Center, Maastricht, Netherlands
| | - Fabio Mosca
- Neonatal Intensive Care Unit, Department of Clinical Sciences and Community Health, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano, Milan, Italy
| | - Eduardo Villamor
- Department of Pediatrics, School for Oncology and Developmental Biology (GROW), Maastricht University Medical Center, Maastricht, Netherlands
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Natarajan G, Shankaran S, Saha S, Laptook A, Das A, Higgins R, Stoll BJ, Bell EF, Carlo WA, D'Angio C, DeMauro SB, Sanchez P, Van Meurs K, Vohr B, Newman N, Hale E, Walsh M. Antecedents and Outcomes of Abnormal Cranial Imaging in Moderately Preterm Infants. J Pediatr 2018; 195:66-72.e3. [PMID: 29395186 PMCID: PMC5869095 DOI: 10.1016/j.jpeds.2017.11.036] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2017] [Revised: 10/09/2017] [Accepted: 11/16/2017] [Indexed: 12/21/2022]
Abstract
OBJECTIVES To describe the frequency and findings of cranial imaging in moderately preterm infants (born at 290/7-336/7 weeks of gestation) across centers, and to examine the association between abnormal imaging and clinical characteristics. STUDY DESIGN We used data from the Neonatal Research Network Moderately Preterm Registry, including the most severe early (≤28 days) and late (>28 days) cranial imaging. Stepwise logistic regression and CART analysis were performed after adjustment for gestational age, antenatal steroid use, and center. RESULTS Among 7021 infants, 4184 (60%) underwent cranial imaging. These infants had lower gestational ages and birth weights and higher rates of small for gestational age, outborn birth, cesarean delivery, neonatal resuscitation, and treatment with surfactant, compared with those without imaging (P < .0001). Imaging abnormalities noted in 15% of the infants included any intracranial hemorrhage (13.2%), grades 3-4 intracranial hemorrhage (1.7%), cystic periventricular leukomalacia (2.6%), and ventriculomegaly (6.6%). Histologic chorioamnionitis (OR, 1.47; 95% CI, 1.19-1.83), gestational age (0.95; 95% CI, 0.94-0.97), antenatal steroids (OR, 0.55; 95% CI, 0.41-0.74), and cesarean delivery (OR, 0.66; 95% CI, 0.53-0.81) were associated with abnormal imaging. The center with the highest rate of cranial imaging, compared with the lowest, had a higher risk of abnormal imaging (OR, 2.08; 95% CI, 1.10-3.92). On the classification and regression-tree model, cesarean delivery, center, antenatal steroids, and chorioamnionitis, in that order, predicted abnormal imaging. CONCLUSION Among the 60% of moderately preterm infants with cranial imaging, 15% had intracranial hemorrhage, cystic periventricular leukomalacia or late ventriculomegaly. Further correlation of imaging and long-term neurodevelopmental outcomes in moderately preterm infants is needed.
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Affiliation(s)
| | | | - Shampa Saha
- RTI International, Research Triangle Park, NC
| | - Abbot Laptook
- Women and Infants Hospital of Rhode Island, Providence, RI
| | - Abhik Das
- RTI International, Research Triangle Park, NC
| | - Rosemary Higgins
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD
| | - Barbara J Stoll
- Department of Pediatrics, UT Health McGovern Medical School, Houston, TX
| | - Edward F Bell
- Department of Pediatrics, University of Iowa, Iowa City, IA
| | - Waldemar A Carlo
- Department of Pediatrics, University of Alabama at Birmingham, Birmingham, AL
| | - Carl D'Angio
- University of Rochester Medical Center, Rochester, NY
| | - Sara B DeMauro
- Department of Pediatrics, University of Pennsylvania, PA
| | - Pablo Sanchez
- Department of Pediatrics, Nationwide Children's Hospital, Ohio State University, Columbus, OH
| | - Krisa Van Meurs
- Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine and Lucile Packard Children's Hospital, Palo Alto, CA
| | - Betty Vohr
- Women and Infants Hospital of Rhode Island, Providence, RI
| | - Nancy Newman
- Department of Pediatrics, Rainbow Babies and Children's Hospital, Case Western Reserve University, Cleveland, OH
| | | | - Michele Walsh
- Department of Pediatrics, Rainbow Babies and Children's Hospital, Case Western Reserve University, Cleveland, OH
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The use of antenatal fetal magnetic resonance imaging in the assessment of patients at high risk of preterm birth. Eur J Obstet Gynecol Reprod Biol 2018; 222:134-141. [DOI: 10.1016/j.ejogrb.2018.01.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2017] [Revised: 01/10/2018] [Accepted: 01/15/2018] [Indexed: 12/30/2022]
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23
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Preclinical chorioamnionitis dysregulates CXCL1/CXCR2 signaling throughout the placental-fetal-brain axis. Exp Neurol 2017; 301:110-119. [PMID: 29117499 DOI: 10.1016/j.expneurol.2017.11.002] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2017] [Revised: 10/28/2017] [Accepted: 11/03/2017] [Indexed: 12/31/2022]
Abstract
In the United States, perinatal brain injury (PBI) is a major cause of infant mortality and childhood disability. For a large proportion of infants with PBI, central nervous system (CNS) injury begins in utero with inflammation (chorioamnionitis/CHORIO) and/or hypoxia-ischemia. While studies show CHORIO contributes to preterm CNS injury and is also a common independent risk factor for brain injury in term infants, the molecular mechanisms mediating inflammation in the placental-fetal-brain axis that result in PBI remain a gap in knowledge. The chemokine (C-X-C motif) ligand 1 (CXCL1), and its cognate receptor, CXCR2, have been clinically implicated in CHORIO and in mature CNS injury, although their specific role in PBI pathophysiology is poorly defined. Given CXCL1/CXCR2 signaling is essential to neural cell development and neutrophil recruitment, a key pathological hallmark of CHORIO, we hypothesized CHORIO would upregulate CXCL1/CXCR2 expression in the placenta and fetal circulation, concomitant with increased CXCL1/CXCR2 signaling in the developing brain, immune cell activation, neutrophilia, and microstructural PBI. On embryonic day 18 (E18), a laparotomy was performed in pregnant Sprague Dawley rats to induce CHORIO. Specifically, uterine arteries were occluded for 60min to induce placental transient systemic hypoxia-ischemia (TSHI), followed by intra-amniotic injection of lipopolysaccharide (LPS). Pups were born at E22. Placentae, serum and brain were collected along an extended time course from E19 to postnatal day (P)15 and analyzed using multiplex electrochemiluminescence (MECI), Western blot, qPCR, flow cytometry (FC) and diffusion tensor imaging (DTI). Results demonstrate that compared to sham, CHORIO increases placental CXCL1 and CXCR2 mRNA levels, concomitant with increased CXCR2+ neutrophils. Interestingly, pup serum CXCL1 expression in CHORIO parallels this increase, with sustained elevation through P15. Analyses of CHORIO brains reveal similarly increased CXCL1/CXCR2 expression through P7, together with increased neutrophilia, microgliosis and peripheral macrophages. Similar to the placenta, cerebral neutrophilia was defined by increased CXCR2 surface expression and elevated myeloperoxidase expression (MPO), consistent with immune cell activation. Evaluation of microstructural brain injury at P15 with DTI reveals aberrant microstructural integrity in the callosal and capsular white matter, with reduced fractional anisotropy in superficial and deep layers of overlying cortex. In summary, using an established model of CHORIO that exhibits mature CNS deficits mimicking those of preterm survivors, we show CHORIO induces injury throughout the placental-fetal-brain axis with a CXCL1/CXCR2 inflammatory signature, neutrophilia, and microstructural abnormalities. These data are concomitant with abnormal cerebral CXCL1/CXCR2 expression, and support temporal aberrations in CXCL1/CXCR2 and neutrophil dynamics in the placental-fetal-brain axis following CHORIO. These investigations define novel targets for directed therapies for infants at high risk for PBI.
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Patel K, Williams S, Guirguis G, Gittens-Williams L, Apuzzio J. Genital tract GBS and rate of histologic chorioamnionitis in patients with preterm premature rupture of membrane. J Matern Fetal Neonatal Med 2017; 31:2624-2627. [PMID: 28715920 DOI: 10.1080/14767058.2017.1350642] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
INTRODUCTION Histologic chorioamnionitis (HC) is a common finding in the placenta from patients with preterm premature rupture of membranes (PPROM). The purpose of this study is to determine if HC differs based on the Group B streptococcus (GBS) status in patients managed expectantly with PPROM <34 weeks gestation. METHODS A retrospective study was performed of patients admitted with PPROM between 23 0/7 and 33 6/7 weeks from 2003 to 2014 at one institution. Patients were excluded if in labor, evidence of clinical chorioamnionitis, nonreassuring fetal status, multifetal gestation, HIV positive, or if GBS specimens or placental histology were not available. Placental pathology results were compared using Fisher's exact test. RESULTS One hundred eighty-one patients met inclusion criteria and 55 (30.3%) were GBS positive. The prevalence of HC did not differ between the GBS positive and GBS negative groups (69 versus 64.2%, respectively; p = .62). Clinical chorioamnionitis, endomyometritis, wound infection, maternal and neonatal sepsis did not differ between the two groups. CONCLUSIONS Vaginal-rectal colonization with GBS on admission does not appear to affect the rate of HC nor neonatal outcome in patients managed conservatively with PPROM <34 weeks gestation.
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Affiliation(s)
- Krunal Patel
- a Department of Obstetrics, Gynecology and Women's Health , Rutgers New Jersey Medical School , Newark , NJ , USA
| | - Shauna Williams
- a Department of Obstetrics, Gynecology and Women's Health , Rutgers New Jersey Medical School , Newark , NJ , USA
| | - George Guirguis
- a Department of Obstetrics, Gynecology and Women's Health , Rutgers New Jersey Medical School , Newark , NJ , USA
| | - Lisa Gittens-Williams
- a Department of Obstetrics, Gynecology and Women's Health , Rutgers New Jersey Medical School , Newark , NJ , USA
| | - Joseph Apuzzio
- a Department of Obstetrics, Gynecology and Women's Health , Rutgers New Jersey Medical School , Newark , NJ , USA
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Chorioamnionitis appears not to be a Risk Factor for Patent Ductus Arteriosus in Preterm Infants: A Systematic Review and Meta-Analysis. Sci Rep 2016; 6:37967. [PMID: 27892517 PMCID: PMC5125028 DOI: 10.1038/srep37967] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2016] [Accepted: 11/03/2016] [Indexed: 12/29/2022] Open
Abstract
The contribution of chorioamnionitis (CA) to mortality and morbidity in preterm infants is difficult to assess because observational studies frequently present significant differences in baseline characteristics of the infants exposed or non-exposed to CA. In an attempt to perform a thorough assessment of the possible association between CA and patent ductus arteriosus (PDA) in preterm infants, we conducted a meta-analysis in which adjusted odds ratios (ORs) were pooled and we analyzed the effects of potential confounders, such as gestational age (GA) or birth weight (BW). We identified 45 relevant studies (27186 patients, 7742 CA cases). Random effects meta-analysis of crude ORs showed a significant positive association between CA and PDA (OR 1.352, 95% CI 1.172 to 1.560). Adjusted ORs were reported in 11 studies (19577 infants). Meta-analysis of these studies showed a significant negative association between CA and PDA (OR 0.802, 95% CI 0.751 to 0.959). Meta-regression showed that the differences in GA or BW between the CA-exposed and non-exposed groups were significantly correlated with the effect size of the association between PDA and CA. In conclusion, our study confirms that confounders need to be taken into account when assessing the association between CA and clinical outcomes in preterm infants.
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Perrone S, Tataranno ML, Negro S, Longini M, Toti MS, Alagna MG, Proietti F, Bazzini F, Toti P, Buonocore G. Placental histological examination and the relationship with oxidative stress in preterm infants. Placenta 2016; 46:72-78. [PMID: 27697224 DOI: 10.1016/j.placenta.2016.08.084] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2016] [Revised: 07/27/2016] [Accepted: 08/22/2016] [Indexed: 12/21/2022]
Abstract
BACKGROUND Prenatal conditions of enhanced oxidative stress (OS) linked to inflammation or hypoxia have been associated with impaired fetal growth and preterm delivery. Little is known regarding biomarkers of OS in the cord blood of preterm infants and placental histological patterns. OBJECTIVES To test the hypothesis that placental lesions indicating chorioamnionitis (CA) or vascular underperfusion (VU) are associated with increased OS in the offspring. METHODS 120 neonates born below 29+6 weeks of gestational age (GA) were enrolled. Histological characteristics of placentas from their mothers were classified as normal (CTRL group), histological CA (HCA) and vascular underperfusion (VU). Serum concentrations of isoprostanes (IsoPs), non-protein bound iron (NPBI) and advanced oxidative protein products (AOPP), were determined in cord blood. RESULTS IsoPs, NPBI and AOPP were significantly increased in HCA group compared to CTRL group. The multivariable regression model, adjusted for GA, maternal age, parity, maternal diabetes, maternal obesity and presence/absence of fetal growth restriction (FGR), showed a significant association between the presence of HCA and increased OS biomarkers levels in cord blood (IsoPs: p = 0.006; NPBI: p = 0.014; AOPP: p = 0.007). Placental VU lesions were significantly associated with higher umbilical IsoPs, NPBI and AOPP levels (IsoPs: p = 0.008; NPBI: p = 0.002; AOPP: p = 0.040). In the cases of placental VU lesions associations were also found between high AOPP levels and low GA (p = 0.002) and the presence of fetal growth restriction (p = 0.014). CONCLUSIONS Placental lesions indicating inflammation or impaired perfusion are associated with higher cord blood levels of OS biomarkers explaining the fetal susceptibility to oxidative injury and the need of antioxidant protection.
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Affiliation(s)
- Serafina Perrone
- Department of Molecular and Developmental Medicine, University of Siena, Siena, Italy.
| | - Maria Luisa Tataranno
- Department of Molecular and Developmental Medicine, University of Siena, Siena, Italy
| | - Simona Negro
- Department of Molecular and Developmental Medicine, University of Siena, Siena, Italy
| | - Mariangela Longini
- Department of Molecular and Developmental Medicine, University of Siena, Siena, Italy; U.O.C, Clinical Pathology, AOUS, Siena, Italy
| | - Maria Stefania Toti
- Department of Molecular and Developmental Medicine, University of Siena, Siena, Italy
| | | | - Fabrizio Proietti
- Department of Molecular and Developmental Medicine, University of Siena, Siena, Italy
| | - Francesco Bazzini
- Department of Molecular and Developmental Medicine, University of Siena, Siena, Italy
| | - Paolo Toti
- Department of Medical Biotechnologies, University of Siena, Siena, Italy
| | - Giuseppe Buonocore
- Department of Molecular and Developmental Medicine, University of Siena, Siena, Italy
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Peri‐intraventricular hemorrhage and oxidative and inflammatory stress markers in very‐low birth weight newborns. JORNAL DE PEDIATRIA (VERSÃO EM PORTUGUÊS) 2015. [DOI: 10.1016/j.jpedp.2015.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Caldas JPS, Braghini CA, Mazzola TN, Vilela MMS, Marba STM. Peri-intraventricular hemorrhage and oxidative and inflammatory stress markers in very-low birth weight newborns. J Pediatr (Rio J) 2015; 91:373-9. [PMID: 25913045 DOI: 10.1016/j.jped.2014.09.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2014] [Revised: 09/21/2014] [Accepted: 09/22/2014] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES To evaluate the association between oxidative and inflammatory stress markers with peri-intraventricular hemorrhage (PIVH) in very-low birth weight newborns. METHODS This was a prospective study conducted in a level III neonatal unit. Basal and stimulated reactive oxygen intermediates (ROIs), reduced glutathione (GSH), and interleukin-6 (IL-6) levels were measured in umbilical cord blood. Newborns underwent serial ultrasound at the bedside, at 6, 12, 24, and 72hours of life and at seven days for the diagnosis of PIVH, classified as grades I to IV. Two groups were assessed, those with and without PIVH; maternal and neonatal control variables were used for comparison. Univariate and multiple regression analyses were applied. RESULTS A total of 125 newborns were assessed. PIVH incidence rate was 12.0%. In the univariate analysis, basal ROI, the use of two or more doses of corticosteroids, birth weight<1,000g, ventilatory support use, and SNAPPE II value ≥ 22 were significantly associated with PIVH. However, in the multivariate analysis, only antenatal steroid use was independently associated with the disease (OR 0,194; 95% CI: 0,048 to 0,773; p=0,02). CONCLUSION ROI, GSH, and IL-6 levels were not associated with the occurrence of PIVH in very-low birth weight infants.
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Affiliation(s)
- Jamil P S Caldas
- Neonatology Division, Hospital da Mulher Prof. Dr. José Aristodemo Pinotti, Centro de Atenção Integral à Saúde da Mulher (CAISM), Universidade Estadual de Campinas (UNICAMP), Campinas, SP, Brazil.
| | - Carolina A Braghini
- Centro de Investigação em Pediatria (CIPED), Universidade Estadual de Campinas (UNICAMP), Campinas, SP, Brazil
| | - Taís N Mazzola
- Centro de Investigação em Pediatria (CIPED), Universidade Estadual de Campinas (UNICAMP), Campinas, SP, Brazil
| | - Maria M S Vilela
- Department of Pediatrics, Faculdade de Ciências Médicas, Universidade Estadual de Campinas (UNICAMP), Campinas, SP, Brazil
| | - Sérgio T M Marba
- Department of Pediatrics, Faculdade de Ciências Médicas, Universidade Estadual de Campinas (UNICAMP), Campinas, SP, Brazil
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Xie A, Zhang W, Chen M, Wang Y, Wang Y, Zhou Q, Zhu X. Related factors and adverse neonatal outcomes in women with preterm premature rupture of membranes complicated by histologic chorioamnionitis. Med Sci Monit 2015; 21:390-5. [PMID: 25644559 PMCID: PMC4325828 DOI: 10.12659/msm.891203] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Background The aim of this study was to identify factors predicting histologic chorioamnionitis (HCA) in women with preterm premature rupture of membranes (PPROM). Material/Methods We retrospectively enrolled 371 women diagnosed with PPROM at less than 34 weeks of gestation at the Second Affiliated Hospital of Wenzhou Medical University between January 2008 and December 2012. HCA was diagnosed by placental histopathology in 70% of participants. Binary logistic regression was used to identify factors associated with HCA and neonatal outcomes. Results Patient age, rate of parity, tocolysis, cesarean section, serum C reactive protein (CRP) level at admission, white blood cell count, and latency duration did not significantly differ between the 2 groups. Binary logistic regression revealed that oligohydramnios at admission, gestational age at PPROM, and serum CRP >8 mg/L before delivery were significantly associated with HCA. Gestational age at delivery and birth weight were significantly lower in HCA patients than control patients. The rate of 1-min Apgar score <7, abnormal neonatal intracranial ultrasound findings, neonatal pneumonia, bronchopulmonary dysplasia, early-onset neonatal sepsis, and mortality were higher in HCA patients, but no significant difference was observed in the incidence of neonatal respiratory distress syndrome, necrotizing enterocolitis, hyperbilirubinemia, or hypoglycemia. Conclusions Younger gestational age at time of PPROM, higher CRP level before delivery, and oligohydramnios at admission in women with PPROM are associated with HCA, and HCA is associated with some adverse neonatal outcomes.
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Affiliation(s)
- Ailan Xie
- Department of Gynecology, Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China (mainland)
| | - Wenwen Zhang
- Department of Gynecology, Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China (mainland)
| | - Miaomiao Chen
- Department of Gynecology, Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China (mainland)
| | - Yuhuan Wang
- Department of Gynecology, econd Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China (mainland)
| | - Ying Wang
- Department of Gynecology, Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China (mainland)
| | - Qingfeng Zhou
- Department of Gynecology, Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China (mainland)
| | - Xueqiong Zhu
- Department of Gynecology, Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China (mainland)
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Cheng T, Xue X, Fu J. Effect of OLIG1 on the development of oligodendrocytes and myelination in a neonatal rat PVL model induced by hypoxia-ischemia. Mol Med Rep 2014; 11:2379-86. [PMID: 25435330 PMCID: PMC4337744 DOI: 10.3892/mmr.2014.3028] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2013] [Accepted: 07/25/2014] [Indexed: 11/05/2022] Open
Abstract
OLIG1 is an oligodendrocyte (OL) transcription factor, which can contribute to the proliferation and differentiation of OLs, and the maturation of myelin. The aim of this study was to clarify the role of OLIG1 in neonatal Sprague Dawley rats with periventricular leukomalacia (PVL), induced by hypoxia‑ischemia (HI). Newborn rats in the HI group were subjected to ligation of the right carotid artery, followed by 8% oxygen delivery for 2 h, while rats in the normoxia group were only subjected to isolation of the right carotid artery, without exposure to hypoxia. Samples of brain tissue from rats in both groups were collected at 1, 3, 7, 14 and 21 days. In the HI group, observation by transmission electron microscopy (TEM) revealed OLs with a damaged nuclear membrane, cellular atrophy, deformation and necrosis, and cells in myelin with a high number of small vacuoles. A double‑label immunofluorescence assay revealed the translocation of OLIG1 from the cytoplasm to the nucleus, while western blot and reverse transcription‑quantitative polymerase chain reaction assays showed that there is a significant decrease, followed by an increase, in the gene and protein expression levels of OLIG1 and myelin basic protein (MBP). Despite the increase at the late stages of HI, the final levels of these proteins remained lower than the corresponding levels in the normoxia group. In conclusion, the decreased protein expression of OLIG1 following HI plays an important role in inhibiting the development and maturation of OLs and myelin. Although OLIG1 may, via its nuclear translocation, promote the growth and development of myelin to a certain extent, this factor fails to fully repair injured myelin.
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Affiliation(s)
- Tongfei Cheng
- Department of Pediatrics, Shengjing Hospital of China Medical University, Shenyang, Liaoning 110004, P.R. China
| | - Xindong Xue
- Department of Pediatrics, Shengjing Hospital of China Medical University, Shenyang, Liaoning 110004, P.R. China
| | - Jianhua Fu
- Department of Pediatrics, Shengjing Hospital of China Medical University, Shenyang, Liaoning 110004, P.R. China
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Kim MA, Lee YS, Seo K. Assessment of predictive markers for placental inflammatory response in preterm births. PLoS One 2014; 9:e107880. [PMID: 25291377 PMCID: PMC4188518 DOI: 10.1371/journal.pone.0107880] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2014] [Accepted: 08/15/2014] [Indexed: 12/02/2022] Open
Abstract
Placental inflammatory response (PIR) is associated with adverse neonatal outcomes such as sepsis, cerebral palsy, low birth weight, preterm birth, and neonatal mortality. However, there is an urgent need for noninvasive and sensitive biomarkers for prediction of PIR. In this study, we evaluated the clinical usefulness of maternal serum inflammatory markers for prediction of PIR in women with impending preterm birth. We conducted a retrospective cohort study of 483 patients who delivered preterm neonates. Serum levels of leukocyte differential counts, C-reactive protein (CRP), and neutrophil to lymphocyte ratio (NLR) were compared between women with no placental inflammation and women with PIR. The mean neutrophil counts, CRP levels, and NLR in both the patients with histologic chorioamnionitis (HCA) alone and those with HCA with funisitis were significantly higher than those in women with no placental inflammation. Compared to leukocyte subset or CRP, NLR in women with funisitis was significantly higher than in women with HCA alone and showed higher predictive accuracy, along with 71.4% sensitivity, 77.9% specificity, 80.7% positive predictive value, and 67.8% negative predictive value for prediction of PIR. On Kaplan-Meier survival analysis, women with both an elevated level of CRP and a high NLR had a shorter admission-to-delivery interval compared to women with either an elevated level of CRP or a high NLR alone. NLR may be a predictive marker of PIR and could be used as a cost-effective parameter for identifying women at risk of PIR.
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Affiliation(s)
- Min-A Kim
- Department of Obstetrics and Gynecology, Gangnam Severance Hospital, Institute of Women’s Life Medical Science, Yonsei University College of Medicine, Seoul, Korea
| | - You Sun Lee
- Department of Obstetrics and Gynecology, Gangnam Severance Hospital, Institute of Women’s Life Medical Science, Yonsei University College of Medicine, Seoul, Korea
| | - Kyung Seo
- Department of Obstetrics and Gynecology, Gangnam Severance Hospital, Institute of Women’s Life Medical Science, Yonsei University College of Medicine, Seoul, Korea
- * E-mail:
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Abstract
The normal development of the kidney may be affected by several factors, including abnormalities in placental function, resulting in fetal growth restriction, exposure to maternal disease states, including hypertension and diabetes, antenatal steroids, chorioamnionitis, and preterm delivery. After preterm birth, several further insults may occur that may influence nephrogenesis and renal health, including exposure to nephrotoxic medications, postnatal growth failure, and obesity after growth restriction. In this review article, common clinical neonatal scenarios are used to highlight these renal risk factors, and the animal and human evidence on which these risk factors are based are discussed.
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Affiliation(s)
- Megan Sutherland
- Department of Anatomy and Developmental Biology, Monash University, Level 3, Boulevard 76, Wellington Road, Clayton, Victoria 3800, Australia
| | - Dana Ryan
- Department of Anatomy and Developmental Biology, Monash University, Level 3, Boulevard 76, Wellington Road, Clayton, Victoria 3800, Australia
| | - M Jane Black
- Department of Anatomy and Developmental Biology, Monash University, Level 3, Boulevard 76, Wellington Road, Clayton, Victoria 3800, Australia
| | - Alison L Kent
- Department of Neonatology, Centenary Hospital for Women and Children, Canberra Hospital, PO Box 11, Woden 2606, Australian Capital Territory, Australia; Australian National University Medical School, Canberra 2601, Australian Capital Territory, Australia.
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Seelbach-Goebel B. Antibiotic Therapy for Premature Rupture of Membranes and Preterm Labor and Effect on Fetal Outcome. Geburtshilfe Frauenheilkd 2013; 73:1218-1227. [PMID: 24771902 PMCID: PMC3964356 DOI: 10.1055/s-0033-1360195] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2013] [Revised: 11/19/2013] [Accepted: 11/19/2013] [Indexed: 10/25/2022] Open
Abstract
In Germany almost 10 % of children are born before the end of 37th week of gestation. In at least one quarter of these cases, ascending infection of the vagina plays a causative role, particularly during the early weeks of gestation. If, in addition to the decidua, the amniotic membrane, amniotic fluid and the umbilical cord are also affected, infection not only triggers uterine contractions and premature rupture of membranes but also initiates a systemic inflammatory reaction on the part of the fetus, which can increase neonatal morbidity. Numerous studies and meta-analyses have found that antibiotic therapy prolongs pregnancy and reduces neonatal morbidity. No general benefit of antibiotic treatment was found for premature uterine contractions. But it is conceivable that a subgroup of pregnant women would benefit from antibiotic treatment. It is important to identify this subgroup of women and offer them targeted treatment. This overview summarizes the current body of evidence on antibiotic treatment for impending preterm birth and the effect on neonatal outcomes.
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Affiliation(s)
- B. Seelbach-Goebel
- Krankenhaus der Barmherzigen Brüder – Klinik St. Hedwig, Lehrstuhl für
Frauenheilkunde und Geburtshilfe der Universität Regensburg,
Regensburg
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Arayici S, Kadioglu Simsek G, Oncel MY, Eras Z, Canpolat FE, Oguz SS, Uras N, Zergeroglu S, Dilmen U. The effect of histological chorioamnionitis on the short-term outcome of preterm infants ≤32 weeks: a single-center study. J Matern Fetal Neonatal Med 2013; 27:1129-33. [PMID: 24093223 DOI: 10.3109/14767058.2013.850668] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND AND OBJECTIVES Chorioamnionitis (CA) is an acute inflammation of the membranes and chorion of the placenta. The aim of this study was to determine the effect of histological CA on the short-term outcome of preterm infants. SUBJECTS AND METHODS The clinical characteristics and outcomes of the preterm infant including respiratory distress syndrome, duration of mechanical ventilation, patent ductus arteriosus (PDA) requiring medical treatment or ligation, necrotizing enterocolitis, bronchopulmonary dysplasia, death and intraventricular hemorrhage (IVH; grade III-IV) were analyzed. RESULTS Two hundred and eighty-one infants born at ≤32 weeks gestational ages were included. Infants were divided into two groups: one with histological CA (n = 145) and without histological CA (n = 136). Mean gestational age was 28.8 ± 2.6 weeks and 29.1 ± 2.5 weeks, and mean birth weight was 1138 ± 350 g and 1210 ± 299 g, respectively. There were no differences in gestational age and birth weight among the groups. Compared with the group, histological CA was associated with early onset sepsis (p = 0.007), PDA (p = 0.003), IVH (p = 0.03), and death (p = 0.04). CONCLUSION Maternal histological CA is an important risk factor for preterm deliveries and associated with serious morbidities such as early onset sepsis, IVH, PDA and increased mortality.
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Galinsky R, Hooper SB, Polglase GR, Moss TJM. Intrauterine inflammation alters fetal cardiopulmonary and cerebral haemodynamics in sheep. J Physiol 2013; 591:5061-70. [PMID: 23878364 DOI: 10.1113/jphysiol.2013.259119] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Intrauterine inflammation impairs fetal pulmonary vascular development and increases cerebral metabolic rate in fetal sheep. We hypothesized that these structural and metabolic effects of intrauterine inflammation would be accompanied by reduced fetal pulmonary blood flow and increased cerebral perfusion. Fetal sheep were instrumented at 112 days of gestation (term is 147 days) for measurement of cardiopulmonary and cerebral haemodynamics. At 118 days ewes were randomly assigned to receive intra-amniotic lipopolysaccharide (LPS, 20 mg from Escherichia coli; n = 7) or saline (control, 4 ml; n = 6). Fetal haemodynamic data were recorded continually from 1 h before intra-amniotic LPS or saline, until 144 h after. Fetal arterial blood was sampled before, and periodically after, intra-amniotic LPS or saline. End-diastolic and mean pulmonary blood flows were significantly lower than control from 48 and 96 h after LPS exposure, respectively, until the end of the experiment. Carotid blood flow was transiently increased at 96 and 120 h after LPS exposure. Carotid arterial oxygen content was lower than control from 48 h after intra-amniotic LPS. Fetal arterial lactate concentration was higher than control between 4 and 12 h after intra-amniotic LPS. Experimental intrauterine inflammation reduces pulmonary blood flow in fetal sheep, over a time course consistent with impaired pulmonary vascular development. Increased carotid blood flow after LPS administration may reflect an inflammation-induced increase in cerebral metabolic demand.
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Affiliation(s)
- Robert Galinsky
- R. Galinsky: The Ritchie Centre, Monash Institute of Medical Research, PO Box 5418, Clayton, Victoria 3168, Australia.
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Tokumasu H, Hinotsu S, Kita F, Kawakami K. Predictive value of clinical chorioamnionitis in extremely premature infants. Pediatr Int 2013; 55:35-8. [PMID: 23279059 DOI: 10.1111/ped.12036] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2011] [Revised: 09/21/2012] [Accepted: 09/26/2012] [Indexed: 11/29/2022]
Abstract
BACKGROUND Clinical chorioamnionitis and histological chorioamnionitis are important risk factors for neonatal complications and neurodevelopmental impairment in premature infants. It is unclear, however, whether a diagnosis of clinical chorioamnionitis is sufficient to establish a diagnosis of histological chorioamnionitis. The aim of this study was to evaluate the predictive value of clinical chorioamnionitis in the diagnosis of histological chorioamnionitis in extremely premature infants. METHODS This study was a secondary analysis of data from the Neonatal Research Network in Japan, a population-based cohort study aimed at identifying the clinical characteristics and morbidity of very low-birthweight infants. Data for extremely premature infants <28 weeks' gestational age from 2003 to 2007, were used. Subset analysis investigated positive predictive value by gestational age. RESULTS Of the 2470 infants analyzed, 786 were diagnosed with clinical chorioamnionitis and 1129 with histological chorioamnionitis. The positive predictive value of clinical chorioamnionitis for histological chorioamnionitis was 86.6% (681/786; 95% confidence interval [CI]: 84.4-88.6%), sensitivity was 60.3% (681/1129; 95%CI: 58.8-61.7%), and specificity was 92.2% (1236/1341; 95%CI: 90.9-93.3%). In subset analysis, the positive predictive value was particularly high at 23 weeks of gestation (89.1%; 115/129), with sensitivity of 65.3% (115/176) and specificity of 89.6% (120/134). CONCLUSIONS The finding that clinical chorioamnionitis is a useful predictor of histological chorioamnionitis provides important insights into the relationship between these two diagnoses, and has important implications in determining the appropriate timing of delivery of extremely premature infants.
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Affiliation(s)
- Hironobu Tokumasu
- Department of Pharmacoepidemiology, Graduate School of Medicine and Public Health, Kyoto University, Kyoto, Japan
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Patterns of placental pathology in preterm infants with a periventricular haemorrhagic infarction: Association with time of onset and clinical presentation. Placenta 2012; 33:839-44. [DOI: 10.1016/j.placenta.2012.06.014] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2012] [Revised: 06/04/2012] [Accepted: 06/19/2012] [Indexed: 11/22/2022]
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Usuda T, Kobayashi T, Sakakibara S, Kobayashi A, Kaneko T, Wada M, Onozuka J, Numata O, Torigoe K, Yamazaki H, Sato T, Nagayama Y, Uchiyama M. Interleukin-6 polymorphism and bronchopulmonary dysplasia risk in very low-birthweight infants. Pediatr Int 2012; 54:471-5. [PMID: 22449275 DOI: 10.1111/j.1442-200x.2012.03625.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND The aim of the present study was to evaluate the role of interleukin (IL)-6-634 polymorphism in neonatal disorders such as bronchopulmonary dysplasia (BPD) and periventricular leukomalacia (PVL) in very low-birthweight (VLBW) infants. METHODS This prospective cohort study included 202 infants (gestational age at birth, 23-34 weeks; birthweight, 500-1499 g). Genotypic analysis (polymerase chain reaction-restriction fragment length polymorphism) was performed with DNA extracted from whole-blood samples. RESULTS Genotype distribution (66.8% CC, 28.2% CG, 5.0% GG) was similar to that in the adult Japanese population. BPD occurred in 85 infants (42.1%) among 202 VLBW infants. The duration of O(2) therapy in infants with CG/GG genotypes was significantly longer than that in infants with the CC genotype (CG/GG vs CC: 40.3 ± 52.2 days vs 28.4 ± 32.6 days, P < 0.05), but the prevalence of BPD was not associated with the CG/GG genotype (CG/GG, 40.0%; CC, 46.3%, P= 0.24). Infants with CG/GG genotypes were more likely to have received postnatal corticosteroid therapy for BPD than those with the CC genotype (CG/GG vs CC: 20.9% vs 11.1%, P = 0.05). PVL occurred in six infants (3.0%). There was no significant difference in the prevalence of PVL among IL-6-634 polymorphisms (CG/GG, 3.0%; CC, 3.0%, P = 0.65). CONCLUSIONS IL-6-634 polymorphism is associated with duration of oxygen therapy in VLBW infants. This suggests that the IL-6-634 polymorphism G allele is an aggravating factor of BPD. IL-6-634 polymorphism is not associated with PVL.
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Affiliation(s)
- Touhei Usuda
- Division of Pediatrics, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan.
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Becker JH, van Rijswijk J, Versteijnen B, Evers ACC, van den Akker ESA, van Beek E, Bolte AC, Rijnders RJP, Mol BWJ, Moons KGM, Porath MM, Drogtrop AP, Schuitemaker NWE, Willekes C, Westerhuis MEMH, Visser GHA, Kwee A. Is intrapartum fever associated with ST-waveform changes of the fetal electrocardiogram? A retrospective cohort study. BJOG 2012; 119:1410-6. [PMID: 22827811 DOI: 10.1111/j.1471-0528.2012.03442.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To investigate the association between maternal intrapartum fever and ST-waveform changes of the fetal electrocardiogram. DESIGN Retrospective cohort study. SETTING Three academic and six non-academic teaching hospitals in the Netherlands. POPULATION Labouring women with a high-risk singleton pregnancy in cephalic position beyond 36 weeks of gestation. METHODS We studied 142 women with fever (≥38.0°C) during labour and 141 women with normal temperature who had been included in two previous studies. In both groups, we counted the number and type of ST-events and classified them as significant (intervention needed) or not significant, based on STAN(®) clinical guidelines. MAIN OUTCOME MEASURES Number and type of ST-events. RESULTS Both univariable and multivariable regression analysis showed no association between the presence of maternal intrapartum fever and the number or type of ST-events. CONCLUSIONS Maternal intrapartum fever is not associated with ST-segment changes of the fetal electrocardiogram. Interpretation of ST-changes in labouring women with fever should therefore not differ from other situations.
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Affiliation(s)
- J H Becker
- Department of Obstetrics and Gynaecology, University Medical Centre Utrecht, the Netherlands.
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Perrone S, Toti P, Toti MS, Badii S, Becucci E, Gatti MG, Marzocchi B, Picardi A, Buonocore G. Perinatal outcome and placental histological characteristics: a single-center study. J Matern Fetal Neonatal Med 2012; 25 Suppl 1:110-3. [PMID: 22348288 DOI: 10.3109/14767058.2012.664344] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE Placental pathology assists in characterizing the antenatal environment and may provide information about the baby's subsequent development. We aim to assess whether histological patterns of placenta are associated with an increased risk of perinatal diseases and to evaluate how different patterns of placental dysfunction can affect the neurodevelopmental outcome. METHODS We analyzed the histopathological characteristics of 105 singleton placentas from infants born between 23 and 31 weeks of gestation and we assessed pair-wise correlations with perinatal diseases. Estimated relative risks were calculated from odds ratios. RESULTS Histological chorioamnionitis (CA group) was detected on 51 of 100 placentas tested. Lesions of uteroplacental circulation (abruption, infarction or thrombosis, perivillous fibrin deposition, syncytial knots; vasculopathy group) were detected on 29. 25 normal placentas served as controls. The incidence of bronchopulmonary dysplasia (BPD) and patent ductus arteriosus (PDA) was higher in CA than in control group. The risk of developing retinopathy of prematurity (ROP), intraventricular hemorrhage (IVH) and PDA was higher in CA than in vasculopathy group. CONCLUSIONS At low gestational age CA, rather than placental lesions of vasculopathy, negatively impacts perinatal outcome. Clinical significance of histologic vasculopathy remains questionable. Other pathophysiological mechanisms than those associated with placental changes may occur following dysfunction of uteroplacental circulation.
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Affiliation(s)
- Serafina Perrone
- Department of Pediatrics, Obstetrics and Reproductive Medicine, University of Siena, Siena, Italy.
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Takenouchi T, Kasdorf E, Engel M, Grunebaum A, Perlman JM. Changing pattern of perinatal brain injury in term infants in recent years. Pediatr Neurol 2012; 46:106-10. [PMID: 22264705 DOI: 10.1016/j.pediatrneurol.2011.11.011] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2011] [Accepted: 11/22/2011] [Indexed: 11/16/2022]
Abstract
Perinatal brain injury in term infants remains a significant clinical problem. Recently a change appears to have occurred in the pattern of such injuries. We sought to characterize the incidence, etiology, clinical manifestations, and outcomes of these injuries. A retrospective chart review identified clinical characteristics of neuroimaging, electroencephalography, and placental pathologic findings. Perinatal depression was defined as hypotonia and the need for respiratory support. From January 2004-December 2009, 29,597 term deliveries occurred. Brain injuries in 33 infants (live term births) included hypoxic-ischemic encephalopathy (n = 8; 0.27/1000), subdural hemorrhage (n = 10; 0.34/1000), intraventricular/intraparenchymal hemorrhage (n = 5; 0.17/1000), and focal cerebral infarctions (n = 4; 0.14/1000). Thirteen of 33 infants (39%) were triaged to a regular nursery. Delayed presentations included apnea (n = 6), desaturation episodes (n = 3), and seizures (n = 4). Twenty of 33 (61%) were admitted directly to the neonatal intensive care unit because of perinatal depression or evolving hypoxic-ischemic encephalopathy. Clinical signs included seizures (n = 12) and apnea (n = 2). Nine of 19 manifested electroencephalographic seizures. Pathology included chorioamnionitis (n = 7) and fetal thrombotic vasculopathy (n = 5). The latter was associated with focal cerebral infarctions in 3/4 cases. Most cases attributable to perinatal brain injury, except for evolving hypoxic-ischemic encephalopathy, are not identified according to any perinatal characteristics until the onset of signs, limiting opportunities for prevention.
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Affiliation(s)
- Toshiki Takenouchi
- Division of Pediatric Neurology, Weill Cornell Medical College, New York-Presbyterian Hospital, New York, New York, USA
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Buhimschi IA, Buhimschi CS. Proteomics/diagnosis of chorioamnionitis and of relationships with the fetal exposome. Semin Fetal Neonatal Med 2012; 17:36-45. [PMID: 22100864 PMCID: PMC3242873 DOI: 10.1016/j.siny.2011.10.002] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Proteomics, a relatively young science, originally emerged as a complement to genomics research. By definition, the goal of proteomics is to provide a snapshot of all the proteins within an organism, tissue or biological sample at a given moment. Proteomics has the ability to single out one or more proteins (biomarkers) that change consistently in affected subjects as compared to those disease-free. From a proteomics perspective, chorioamnionitis poses both challenges and opportunities. Challenges relate to the dynamic course of the inflammatory process, and compartmentalization of the gestational sac in relation to the maternal compartment. An inability to evaluate the amniotic fluid non-invasively and repeatedly for meaningful changes in its proteome, and lack of a true gold standard for diagnosis of inflammation and/or infection, represent additional challenges. On the other hand, the unbiased and holistic nature of proteomics offers a real opportunity to improve the current diagnostic and prognostic algorithms for chorioamnionitis. Even at this current stage there are reasons to believe that proteomic biomarkers will improve the understanding of how chorioamnionitis programs or affects the fetus in utero, thus defining its exposome (sum of interactions between genetic make-up of the fetus and the intrauterine environment) of pregnancies affected by infection and/or inflammation. This review summarizes the results of proteomics studies that have aimed or reached these goals.
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Affiliation(s)
- Irina A Buhimschi
- Department of Obstetrics, Gynecology and Reproductive Science, Yale University School of Medicine, 333 Cedar Street, LLCI 804, New Haven, CT 06520, USA.
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Bessières B, Bernard P. [Chorio-amnionitis: clinical and biological aspects--medicolegal implications]. ACTA ACUST UNITED AC 2011; 39:383-7. [PMID: 21602077 DOI: 10.1016/j.gyobfe.2011.04.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2011] [Accepted: 02/07/2011] [Indexed: 10/18/2022]
Abstract
The authors present fetal and maternal risks in chorio-amnionitis diseases. Major fetal risk is the increase of the rate of cerebral palsy which is growing to five. The protocol of 2011 is presented for the prevention and treatment of chorio-amnionitis in premature rupture of the membranes in relation with gestational age. A French statistical survey, period 2001 to 2006, indicates maternal risks of chorio-amnionitis. Medicolegal implications of the chorio-amnionitis diseases emphasize the importance of placental investigations and bacteriological tests.
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Affiliation(s)
- B Bessières
- Histo-embryologie et cytogénétique, CHU Necker, 149, rue de Sèvres, 75015 Paris, France
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Rovira N, Alarcon A, Iriondo M, Ibañez M, Poo P, Cusi V, Agut T, Pertierra A, Krauel X. Impact of histological chorioamnionitis, funisitis and clinical chorioamnionitis on neurodevelopmental outcome of preterm infants. Early Hum Dev 2011; 87:253-7. [PMID: 21354722 DOI: 10.1016/j.earlhumdev.2011.01.024] [Citation(s) in RCA: 67] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2010] [Revised: 12/20/2010] [Accepted: 01/03/2011] [Indexed: 01/07/2023]
Abstract
BACKGROUND The role of chorioamnionitis in neurodevelopment of preterm infants is not fully understood. AIM To examine the association between different indicators of intrauterine inflammation (clinical chorioamnionitis, histological chorioamnionitis and funisitis) and neurodevelopmental impairment in very preterm infants. METHODS Preterm infants with a birth weight of <1500 g or a gestational age of <32 weeks were included. Follow-up evaluation up to 2 years of age consisted of neurological examination, neurodevelopmental assessment and visual and audiologic tests. Outcome data were compared between the chorioamnionitis and the control groups, controlling for gestational age, birth weight and Apgar score at 5 min. RESULTS One hundred seventy-seven patients comprised the study population (mean gestational age 29±2 weeks, mean birth weight 1167±344 g). Histological chorioamnionitis was present in 49% of placentas, whereas funisitis was observed in 25%. In 57% cases clinical maternal chorioamnionitis was suspected. Follow-up was available for 130 (82%) patients. Infants with funisitis, compared with controls, had a significantly higher incidence of moderate to severe disability (18% vs 5%, OR 4.07; 95% CI 1.10-15.09). CONCLUSION The results of this study suggest that, unlike a broad definition of histological chorioamnionitis including inflammation of maternal or fetal placental tissues, funisitis may entail a higher risk of moderate to severe disability at 2 years of age in preterm infants.
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Affiliation(s)
- Nuria Rovira
- Department of Neonatology, Sant Joan de Déu University Hospital, Barcelona, Spain.
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Rours GIJG, de Krijger RR, Ott A, Willemse HFM, de Groot R, Zimmermann LJI, Kornelisse RF, Verbrugh HA, Verkooijen RP. Chlamydia trachomatis and placental inflammation in early preterm delivery. Eur J Epidemiol 2011; 26:421-8. [PMID: 21431838 PMCID: PMC3109244 DOI: 10.1007/s10654-011-9569-2] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2010] [Accepted: 03/09/2011] [Indexed: 11/09/2022]
Abstract
Chlamydiatrachomatis may infect the placenta and subsequently lead to preterm delivery. Our aim was to evaluate the relationship between the presence of Chlamydiatrachomatis and signs of placental inflammation in women who delivered at 32 weeks gestation or less. Setting: placental histology and clinical data were prospectively obtained from 304 women and newborns at the Erasmus MC-Sophia, Rotterdam, the Netherlands. C.trachomatis testing of placentas was done retrospectively using PCR. C.trachomatis was detected in 76 (25%) placentas. Histological evidence of placental inflammation was present in 123 (40%) placentas: in 41/76 (54%) placentas with C.trachomatis versus 82/228 (36%) placentas without C.trachomatis infection (OR 2.1, 95% CI 1.2–3.5). C.trachomatis infection correlated with the progression (P = 0.009) and intensity (P = 0.007) of materno-fetal placental inflammation. C.trachomatis DNA was frequently detected in the placenta of women with early preterm delivery, and was associated with histopathological signs of placental inflammation.
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Affiliation(s)
- G Ingrid J G Rours
- Department of Paediatric Infectious Disease and Immunology, Erasmus MC, Rotterdam, The Netherlands.
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Hendson L, Russell L, Robertson CMT, Liang Y, Chen Y, Abdalla A, Lacaze-Masmonteil T. Neonatal and neurodevelopmental outcomes of very low birth weight infants with histologic chorioamnionitis. J Pediatr 2011; 158:397-402. [PMID: 20961565 DOI: 10.1016/j.jpeds.2010.09.010] [Citation(s) in RCA: 75] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2010] [Revised: 07/12/2010] [Accepted: 09/02/2010] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To determine survival and neurodevelopmental outcomes at 18 months corrected age among very low birth weight infants ≤ 32 weeks gestation with histologic chorioamnionitis. STUDY DESIGN Observational, regionalized, single-center cohort study with prospective follow-up. RESULTS Of the 628 infants meeting the selection criteria, 303 (48%) were born to mothers with evidence of histologic chorioamnonitis. Neonates with histologic chorioamnonitis were of lower gestational age and birth weight. On univariate analysis, they were more likely to have hypotension, bronchopulmonary dysplasia, severe intraventricular hemorrhage, severe retinopathy of prematurity, early-onset sepsis, and death. Infants with histologic chorioamnonitis were more likely to have any neurodevelopmental impairment, specifically, mental delay with a lower mental developmental index. When adjusting for perinatal variables, histologic chorioamnonitis had a protective effect on mortality rates (adjusted OR = 0.44, 95% CI: 0.24-0.8; P = .01; n = 619), had a nonsignificant effect on neurodevelopmental impairment (adjusted odds ratio = 1.33, 95% CI: 0.82-2.17; P = .25; n = 496), and was associated with a 4-point lower mental developmental index at 18-months follow-up (adjusted difference -3.93, 95% CI: -7.52 to -0.33; P = .03; n = 496). CONCLUSIONS Although infants with histologic chorioamnonitis were at an increased risk for death and neurodevelopmental impairment, after multivariate analyses, histologic chorioamnonitis was not associated with adverse long-term outcomes. Results suggest fetal protection from treatment-responsive maternal infection and inflammation.
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Affiliation(s)
- Leonora Hendson
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canda
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Kacerovsky M, Drahosova M, Andrys C, Hornychova H, Tambor V, Lenco J, Tosner J, Krejsek J. Amniotic fluid concentrations of soluble scavenger receptor for hemoglobin (sCD163) in pregnancy complicated by preterm premature rupture of the membranes and histologic chorioamnionitis. J Matern Fetal Neonatal Med 2010; 24:995-1001. [DOI: 10.3109/14767058.2010.538453] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Clinical characterization and long-term prognosis of neurological development in preterm infants with late-onset circulatory collapse. J Perinatol 2010; 30:751-6. [PMID: 20357811 PMCID: PMC2994595 DOI: 10.1038/jp.2010.41] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To characterize the risk factors for late-onset circulatory collapse (LCC) in preterm infants responsive to corticosteroid therapy and evaluate the long-term neurological prognosis. STUDY DESIGN A retrospective case-control study for preterm infants (≤32 weeks' gestation) admitted to our neonatal intensive care unit from 1994 through 2002. RESULT Sixty-five infants (11%) were diagnosed with LCC. Infants with a shorter gestation and lower birth weight had a higher incidence of LCC. LCC infants had a significantly lower 1-min Apgar score, significantly higher incidence of severe intraventricular hemorrhage, chronic lung disease, and postnatal periventricular leukomalacia, and significantly longer duration of ventilation use, oxygen use, and hospital stay. Somatic growth at 36 weeks' postmenstrual age was poorer in infants with LCC than without LCC (controls). LCC infants were significantly more likely than controls to have cerebral palsy at 3 years. CONCLUSION LCC is associated with poor neurodevelopmental outcomes. Prevention of LCC can lead to improved neurological prognoses.
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Kallankari H, Kaukola T, Ojaniemi M, Herva R, Perhomaa M, Vuolteenaho R, Kingsmore SF, Hallman M. Chemokine CCL18 predicts intraventricular hemorrhage in very preterm infants. Ann Med 2010; 42:416-25. [PMID: 20608885 DOI: 10.3109/07853890.2010.481085] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Intraventricular hemorrhage (IVH) in very preterm infants is a common disease associated with long-term consequences. Risk factors of IVH remain to be further defined. AIMS To determine whether specific immunoproteins at birth predict the risk of IVH and whether their receptors are localized at the bleeding site. METHODS A prospective cohort consisted of 163 infants born before 32 weeks of gestation. Altogether 107 cord blood immunoproteins and 12 cytokines from peripheral blood obtained 1 and 7 days after birth were analyzed. Serial brain ultrasounds were assessed. Immunohistochemistry of a chemokine receptor from 14 autopsies was studied. RESULTS Low levels of cord chemokine CCL18 (chemokine (C-C motif) ligand 18) robustly predicted the risk of IVH grade II-IV when ante- and neonatal risk factors were considered. Cord CCL18 increased from 32 weeks to term. During the first week after very preterm birth CCL18 increased as the risk of new IVH cases decreased. CCL18 receptor, CCR3, was detectable in choroid plexus, periventricular capillary endothelium, ependymal cells, and in germinal matrix. CONCLUSION Low cord blood CCL18 is an independent risk factor of IVH. CCL18 may inhibit signal transduction of its receptor in periventricular cells. Defining the function and regulation of CCL18 may help to decrease the risk of IVH.
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Affiliation(s)
- Hanna Kallankari
- Institute of Clinical Medicine, Department of Pediatrics, University of Oulu, FIN-90014, Oulu, Finland
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Becroft DMO, Thompson JMD, Mitchell EA. Placental chorioamnionitis at term: epidemiology and follow-up in childhood. Pediatr Dev Pathol 2010; 13:282-90. [PMID: 19888869 DOI: 10.2350/09-06-0659-oa.1] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The objective was to identify histologic chorioamnionitis ("amnionitis") in the placental disc at term and to investigate associations with demographic, lifestyle, and pregnancy factors and with allergic diseases, atopy, and intelligence quotients in childhood. The setting was a population-based case control study of small-for-gestational age infants at term. One thousand and twelve placentas were assessed histologically for amniocentric inflammation of fetal and/or maternal origin using conservative criteria. Data were collected at birth by maternal interview and from medical records. Follow-up data were obtained from 439 and 418 children at 3.5 and 7 years of age, respectively. Amnionitis was identified in 145 placentas (14.3%), with maternal reaction in 97.2% and fetal reaction in 48.3%. In multivariable analysis any amnionitis was significantly associated with a time from membrane rupture to delivery of 6 to 12 hours, but not with times beyond 12 hours, a duration of total labor exceeding 12 hours, ethnicity (incidences ranging from 8.8% in Indians to 23.5% in Chinese), male infant gender, and anaesthesia during labor, and amnionitis was negatively associated with induction of labor. No associations were found with later allergic disease, atopy, or intelligence quotients. This high incidence of histologic amnionitis at term is similar to historical estimates, despite large reductions in time-related risk factors during labor. Significant ethnic variations contribute to the high incidence and are unexplained, but variation in genetic polymorphisms for susceptibility factors is a possibility. "Silent" histologic amnionitis is a frequent cause of fetal immune activation with potential effects in later life.
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Affiliation(s)
- David M O Becroft
- Department of Paediatrics, University of Auckland, Private Bag 92019, Auckland, New Zealand
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