1
|
Lin Q, Wang Y, Huang Y, Zhu W, Jiang S, Gu X, Sun J, Lee SK, Zhou W, Zhuang D, Cao Y. Association of Antenatal Corticosteroids with Neonatal Outcomes among Very Preterm Infants Born to Mothers with Clinical Chorioamnionitis: A Multicenter Cohort Study. CHILDREN (BASEL, SWITZERLAND) 2024; 11:680. [PMID: 38929259 PMCID: PMC11202040 DOI: 10.3390/children11060680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/22/2024] [Revised: 05/26/2024] [Accepted: 05/26/2024] [Indexed: 06/28/2024]
Abstract
The objective of this study was to assess the relationship of ACS with neonatal outcomes among very preterm infants born to mothers with clinical chorioamnionitis in China. This was a multicenter retrospective cohort study. Study participants included infants born at <32 weeks' gestation with clinical chorioamnionitis and registered in the Chinese Neonatal Network from 1 January 2019 to 31 December 2020. Infants were divided into two groups: any amount of ACS or no administration of ACS. Multivariable generalized linear models using generalized estimating equations were used to assess the association between ACS and neonatal outcomes among the study population. We identified 2193 infants eligible for this study; 1966 (89.6%) infants had received ACS therapy, and 227 (10.4%) had not received any ACS therapy. Among very preterm infants born to mothers with clinical chorioamnionitis, any ACS usage was significantly associated with decreased risks of early death (aRR 0.56, 95% CI 0.32, 0.99) and severe ROP (aRR 0.51, 95% CI 0.28, 0.93) after adjustment for maternal hypertension, gestational age at birth, Caesarean section, being inborn, and administration of systemic antibiotics to the mother within 24 h before birth. In addition, out of the 2193 infants, the placentas of 1931 infants underwent pathological examination with recorded results. Subsequently, 1490 of these cases (77.2%) were diagnosed with histological chorioamnionitis. In 1490 cases of histologic chorioamnionitis, any ACS usage was significantly related to decreased risks of overall mortality (aRR 0.52, 95% CI 0.31, 0.87), severe ROP (aRR 0.47, 95% CI 0.25, 0.97), and respiratory distress syndrome (aRR 0.52, 95% CI 0.31, 0.87). We concluded that any ACS was associated with reduced risks for neonatal early death and severe ROP among very preterm infants born to mothers with clinical chorioamnionitis.
Collapse
Affiliation(s)
- Qingqing Lin
- Division of Neonatology, Xiamen Children’s Hospital (Children’s Hospital of Fudan University at Xiamen), Xiamen 361006, China; (Q.L.); (Y.H.); (W.Z.)
| | - Yanchen Wang
- NHC Key Laboratory of Neonatal Diseases, Fudan University, Children’s Hospital of Fudan University, Shanghai 201102, China; (Y.W.); (S.J.); (X.G.)
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON L8S 4L8, Canada
| | - Ying Huang
- Division of Neonatology, Xiamen Children’s Hospital (Children’s Hospital of Fudan University at Xiamen), Xiamen 361006, China; (Q.L.); (Y.H.); (W.Z.)
| | - Wei Zhu
- Division of Neonatology, Xiamen Children’s Hospital (Children’s Hospital of Fudan University at Xiamen), Xiamen 361006, China; (Q.L.); (Y.H.); (W.Z.)
| | - Siyuan Jiang
- NHC Key Laboratory of Neonatal Diseases, Fudan University, Children’s Hospital of Fudan University, Shanghai 201102, China; (Y.W.); (S.J.); (X.G.)
- Division of Neonatology, Children’s Hospital of Fudan University, Shanghai 201102, China
| | - Xinyue Gu
- NHC Key Laboratory of Neonatal Diseases, Fudan University, Children’s Hospital of Fudan University, Shanghai 201102, China; (Y.W.); (S.J.); (X.G.)
| | - Jianhua Sun
- Department of Neonatology, Shanghai Children’s Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai 200127, China;
| | - Shoo K. Lee
- Maternal-Infants Care Research Centre, and Department of Pediatrics, Mount Sinai Hospital, Toronto, ON M5G 1X5, Canada;
- Department of Pediatrics, The University of Toronto, Toronto, ON M5T 3M7, Canada
| | - Wenhao Zhou
- Guangzhou Women and Children’s Medical Center, Guangzhou Medical University, Guangzhou 510623, China;
| | - Deyi Zhuang
- Fujian Key Laboratory of Neonatal Diseases, Xiamen Key Laboratory of Neonatal Diseases, Xiamen Children’s Hospital (Children’s Hospital of Fudan University at Xiamen), Xiamen 361006, China
| | - Yun Cao
- NHC Key Laboratory of Neonatal Diseases, Fudan University, Children’s Hospital of Fudan University, Shanghai 201102, China; (Y.W.); (S.J.); (X.G.)
- Division of Neonatology, Children’s Hospital of Fudan University, Shanghai 201102, China
| | | |
Collapse
|
2
|
Pereira-Fantini PM, Tingay D, Lakshminrusimha S. A complex inflammatory mix: chorioamnionitis, antenatal steroids and early postnatal budesonide. Pediatr Res 2024:10.1038/s41390-024-03219-y. [PMID: 38724647 DOI: 10.1038/s41390-024-03219-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2024] [Accepted: 04/02/2024] [Indexed: 06/12/2024]
Affiliation(s)
- Prue M Pereira-Fantini
- Department of Paediatrics, University of Melbourne, Melbourne, VIC, Australia.
- Neonatal Research, Murdoch Children's Research Institute, Parkville, VIC, Australia.
| | - David Tingay
- Department of Paediatrics, University of Melbourne, Melbourne, VIC, Australia
- Neonatal Research, Murdoch Children's Research Institute, Parkville, VIC, Australia
| | | |
Collapse
|
3
|
Jain VG, Ambalavanan N. Is there a role for early postnatal steroids in very preterm infants exposed to chorioamnionitis? Pediatr Res 2024; 95:867-868. [PMID: 38245632 PMCID: PMC10920195 DOI: 10.1038/s41390-024-03031-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Accepted: 12/29/2023] [Indexed: 01/22/2024]
Affiliation(s)
- Viral G Jain
- Division of Neonatology, Department of Pediatrics, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Namasivayam Ambalavanan
- Division of Neonatology, Department of Pediatrics, University of Alabama at Birmingham, Birmingham, AL, USA.
| |
Collapse
|
4
|
Hillman NH, Kemp MW, Royse E, Grzych H, Usada H, Ikeda H, Takahashi Y, Takahashi T, Jobe AH, Fee E. Postnatal budesonide improved lung function in preterm lambs exposed to antenatal steroids and chorioamnionitis. Pediatr Res 2024:10.1038/s41390-024-03092-9. [PMID: 38368498 DOI: 10.1038/s41390-024-03092-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 12/29/2023] [Accepted: 01/17/2024] [Indexed: 02/19/2024]
Abstract
BACKGROUND A combination of budesonide and surfactant decreases the rates of BPD in infants and lung injury in preterm sheep. Whether this combination will show benefit in the setting of chorioamnionitis and antenatal steroids is not known. METHODS Ewes at 123 ± 1 day gestational age received intra-amniotic (IA) injections of 10 mg LPS before being randomized to receive either 0.25 mg/kg maternal betamethasone phosphate and acetate or saline by intramuscular (IM) injection at 48 and 24 h prior to delivery at 125 ± 1 day. Lambs (N = 6-9/group) underwent intentionally injurious ventilation for 15 min, then lambs received surfactant mixed with either: (1) saline; or (2) Budesonide 0.25 mg/kg and were ventilated for 4 h. RESULTS Compared with LPS-exposed animals that received no IM steroid treatment, betamethasone exposed fetuses had improved hemodynamic stability, lung compliance, and ventilation efficiency. The addition of budesonide to surfactant further improved markers of injury and pro-inflammatory cytokine mRNA in both betamethasone IM or no IM lambs exposed to LPS IA. Antenatal betamethasone and IA LPS exposures decreased budesonide levels in the fetal lung and plasma. CONCLUSION Antenatal betamethasone stabilizes physiologic parameters in LPS treated lambs. Budesonide mixed with surfactant further decreases injury and improves respiratory physiology in betamethasone treated animals. IMPACT Antenatal betamethasone improved lung and systemic physiology in the setting of intra-amniotic LPS. The addition of budesonide to the surfactant further improved lung function. Budesonide levels in the plasma and lung were lower in lambs exposed to either LPS or LPS and Betamethasone animals, and these findings were not explained by increased esterification in the lungs. The combination of antenatal steroids and budesonide with surfactant had the lowest markers of pro-inflammatory cytokines in the lung of LPS exposed animals.
Collapse
Affiliation(s)
- Noah H Hillman
- Division of Neonatology, Cardinal Glennon Children's Hospital, Saint Louis University, Saint Louis, MO, 63104, USA.
| | - Matthew W Kemp
- School of Women's and Infants' Health, University of Western Australia, Perth, WA, 6009, Australia
- Department of Obstetrics and Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, 119228, Singapore
| | - Emily Royse
- Division of Neonatology, Cardinal Glennon Children's Hospital, Saint Louis University, Saint Louis, MO, 63104, USA
| | - Hayley Grzych
- Division of Neonatology, Cardinal Glennon Children's Hospital, Saint Louis University, Saint Louis, MO, 63104, USA
| | - Haruo Usada
- School of Women's and Infants' Health, University of Western Australia, Perth, WA, 6009, Australia
| | - Hideyuki Ikeda
- School of Women's and Infants' Health, University of Western Australia, Perth, WA, 6009, Australia
| | - Yuki Takahashi
- School of Women's and Infants' Health, University of Western Australia, Perth, WA, 6009, Australia
| | - Tsukasa Takahashi
- School of Women's and Infants' Health, University of Western Australia, Perth, WA, 6009, Australia
| | - Alan H Jobe
- School of Women's and Infants' Health, University of Western Australia, Perth, WA, 6009, Australia
- Division of Pulmonary Biology, Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, OH, 45229, USA
| | - Erin Fee
- School of Women's and Infants' Health, University of Western Australia, Perth, WA, 6009, Australia
| |
Collapse
|
5
|
Korček P, Širc J, Berka I, Kučera J, Straňák Z. Does perinatal management have the potential to reduce the risk of intraventricular hemorrhage in preterm infants? Front Pediatr 2024; 12:1361074. [PMID: 38357510 PMCID: PMC10864433 DOI: 10.3389/fped.2024.1361074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2023] [Accepted: 01/18/2024] [Indexed: 02/16/2024] Open
Abstract
Background Intraventricular hemorrhage (IVH) is an important cause of neurodevelopmental impairment in preterm infants. A number of risk factors for IVH have already been proposed; however, some controversies regarding optimal perinatal management persist. This study aimed to identify perinatal and neonatal attributes associated with IVH in a representative population of preterm infants. Methods Perinatal data on 1,279 very preterm infants (<32 weeks of gestation) admitted to a tertiary neonatal intensive care unit were analyzed. The records were assessed using univariate analysis and logistic regression model to evaluate the risk factors for any and high-grade IVH (grade III-IV according to the classification by Papile) within the first week after birth. Results The incidence of any IVH was 14.3% (183/1,279); the rate of low-grade (I-II) and high-grade (III-IV) IVH was 9.0% (115/1,279) and 5.3% (68/1,279), respectively. Univariate analysis revealed multiple factors significantly associated with intraventricular hemorrhage: lower gestational age and birth weight, absence of antenatal steroids, vaginal delivery, low Apgar score at 5 min, delivery room intubation, surfactant administration, high frequency oscillation, pulmonary hypertension, pulmonary hemorrhage, tension pneumothorax, persistent ductus arteriosus, hypotension and early onset sepsis. Logistic regression confirmed lower gestational age, vaginal delivery, ductus arteriosus and early onset sepsis to be independent predictors for any IVH. Pulmonary hemorrhage, tension pneumothorax and early onset sepsis were independent risk factors for high-grade IVH. Complete course of antenatal steroids was associated with a lower risk for any (odds ratio 0.58, 95% confidence interval 0.39-0.85; P = .006) and for high-grade intraventricular hemorrhage (odds ratio 0.36, 95% confidence interval 0.20-0.65; P < .001). Conclusion The use of antenatal steroids and mode of delivery are crucial in the prevention of IVH; however, our study did not confirm the protective effect of placental transfusion. Severe respiratory insufficiency and circulatory instability remain to be powerful contributors to the development of IVH. Early detection and management of perinatal infection may also help to reduce the rate of brain injury and improve neurodevelopment in high-risk newborns.
Collapse
Affiliation(s)
- Peter Korček
- Neonatal Intensive Care Unit, Institute for the Care of Mother and Child, Prague, Czech Republic
- Third Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Jan Širc
- Neonatal Intensive Care Unit, Institute for the Care of Mother and Child, Prague, Czech Republic
- Third Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Ivan Berka
- Neonatal Intensive Care Unit, Institute for the Care of Mother and Child, Prague, Czech Republic
- Third Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Jáchym Kučera
- Neonatal Intensive Care Unit, Institute for the Care of Mother and Child, Prague, Czech Republic
| | - Zbyněk Straňák
- Neonatal Intensive Care Unit, Institute for the Care of Mother and Child, Prague, Czech Republic
- Third Faculty of Medicine, Charles University, Prague, Czech Republic
| |
Collapse
|
6
|
Ubom AE, Vatish M, Barnea ER. FIGO good practice recommendations for preterm labor and preterm prelabor rupture of membranes: Prep-for-Labor triage to minimize risks and maximize favorable outcomes. Int J Gynaecol Obstet 2023; 163 Suppl 2:40-50. [PMID: 37807588 DOI: 10.1002/ijgo.15113] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/10/2023]
Abstract
Preterm labor occurs in around 10% of pregnancies worldwide. Once diagnosed, significant efforts must be made to reduce the likelihood of morbidity and mortality associated with preterm birth. In high-resource settings, access to hospitals with a neonatal intensive care unit (NICU) is readily available, whereas access to NICU care is limited in low- and middle-income countries (LMICs) and many rural settings. Use of FIGO's Prep-for-Labor triage method rapidly identifies low- and high-risk patients with preterm labor to enable clinicians to decide whether the patient can be managed on site or if transfer to a level II-IV facility is needed. The management steps described in this paper aim to minimize the morbidity and mortality associated with preterm labor and in the setting of preterm labor with preterm premature rupture of membranes (PPROM). The methods for accurate diagnosis of PPROM and chorioamnionitis are described. When the risk of preterm birth is high, antenatal corticosteroids should be administered for lung maturation combined with limited tocolysis for 48 hours to permit the corticosteroid course to be completed. Magnesium sulfate is also administered for fetal neuroprotection. Implementation of FIGO's Prep-for-Labor triage method in an LMIC setting will help improve maternal and neonatal outcomes.
Collapse
Affiliation(s)
- Akaninyene Eseme Ubom
- Department of Obstetrics, Gynecology and Perinatology, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria
| | - Manu Vatish
- Bill and Melinda Gates Foundation, Seattle, Washington, USA
- Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford, UK
| | - Eytan R Barnea
- Society for the Investigation of Early Pregnancy (SIEP), New York, New York, USA
- Obstetrics Gynecology & Reproductive Sciences University of Miami Miller School of Medicine, Miami, Florida, USA
| |
Collapse
|
7
|
Saito K, Nishimura E, Ota E, Namba F, Swa T, Ramson J, Lavin T, Cao J, Vogel JP. Antenatal corticosteroids in specific groups at risk of preterm birth: a systematic review. BMJ Open 2023; 13:e065070. [PMID: 37739474 PMCID: PMC10533784 DOI: 10.1136/bmjopen-2022-065070] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Accepted: 09/01/2023] [Indexed: 09/24/2023] Open
Abstract
OBJECTIVE This study aimed to synthesise available evidence on the efficacy of antenatal corticosteroid (ACS) therapy among women at risk of imminent preterm birth with pregestational/gestational diabetes, chorioamnionitis or fetal growth restriction (FGR), or planned caesarean section (CS) in the late preterm period. METHODS A systematic search of MEDLINE, EMBASE, CINAHL, Cochrane Library, Web of Science and Global Index Medicus was conducted for all comparative randomised or non-randomised interventional studies in the four subpopulations on 6 June 2021. Risk of Bias Assessment tool for Non-randomised Studies and the Cochrane Risk of Bias tool were used to assess the risk of bias. Grading of Recommendations Assessment, Development and Evaluations tool assessed the certainty of evidence. RESULTS Thirty-two studies involving 5018 pregnant women and 10 819 neonates were included. Data on women with diabetes were limited, and evidence on women undergoing planned CS was inconclusive. ACS use was associated with possibly reduced odds of neonatal death (pooled OR: 0.51; 95% CI: 0.31 to 0.85, low certainty), intraventricular haemorrhage (pooled OR: 0.41; 95% CI: 0.23 to 0.72, low certainty) and respiratory distress syndrome (pooled OR: 0.59; 95% CI: 0.45 to 0.77, low certainty) in women with chorioamnionitis. Among women with FGR, the rates of surfactant use (pooled OR: 0.38; 95% CI: 0.23 to 0.62, moderate certainty), mechanical ventilation (pooled OR: 0.42; 95% CI: 0.26 to 0.66, moderate certainty) and oxygen therapy (pooled OR: 0.48; 95% CI: 0.30 to 0.77, moderate certainty) were probably reduced; however, the rate of hypoglycaemia probably increased (pooled OR: 2.06; 95% CI: 1.27 to 3.32, moderate certainty). CONCLUSIONS There is a paucity of evidence on ACS for women who have diabetes. ACS therapy may have benefits in women with chorioamnionitis and is probably beneficial in FGR. There is limited direct trial evidence on ACS efficacy in women undergoing planned CS in the late preterm period, though the totality of evidence suggests it is probably beneficial. PROSPERO REGISTRATION NUMBER CRD42021267816.
Collapse
Affiliation(s)
- Kana Saito
- Pediatrics, Saitama Medical Center, Kawagoe, Saitama, Japan
| | - Etsuko Nishimura
- Graduate School of Nursing Science, St Luke's International University, Chuo-ku, Tokyo, Japan
| | - Erika Ota
- Graduate School of Nursing Science, St Luke's International University, Chuo-ku, Tokyo, Japan
- The Tokyo Foundation for Policy Research, Minato-ku, Tokyo, Japan
| | - Fumihiko Namba
- Pediatrics, Saitama Medical Center, Kawagoe, Saitama, Japan
| | - Toshiyuki Swa
- Division of Health Science, Osaka University School of Medicine Graduate School of Medicine, Suita, Osaka, Japan
| | - Jenny Ramson
- Maternal, Child and Adolescent Health Program, Burnet Institute, Melbourne, Victoria, Australia
| | - Tina Lavin
- Department of Sexual and Reproductive Health and Research, World Health Organization, Geneve, Switzerland
| | - Jenny Cao
- Maternal, Child and Adolescent Health Program, Burnet Institute, Melbourne, Victoria, Australia
| | - Joshua Peter Vogel
- Maternal, Child and Adolescent Health Program, Burnet Institute, Melbourne, Victoria, Australia
| |
Collapse
|
8
|
The Association of Patent Ductus Arteriosus with Inflammation: A Narrative Review of the Role of Inflammatory Biomarkers and Treatment Strategy in Premature Infants. Int J Mol Sci 2022; 23:ijms232213877. [PMID: 36430355 PMCID: PMC9699120 DOI: 10.3390/ijms232213877] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Revised: 10/27/2022] [Accepted: 11/07/2022] [Indexed: 11/12/2022] Open
Abstract
Patent ductus arteriosus (PDA) is a common cardiovascular complication that complicates clinical care in the intensive care of premature infants. Prenatal and postnatal infections and the inflammation process can contribute to PDA, and intrauterine inflammation is a known risk factor of PDA. A variety of inflammatory biomarkers have been reported to be associated with PDA. Chorioamnionitis induces the fetal inflammatory process via several cytokines that have been reported to be associated with the presence of PDA and may have a role in the vascular remodeling process or vessel dilation of the ductus. On the other hand, anti-inflammatory agents, such as antenatal steroids, decrease PDA incidence and severity in patients born to those with chorioamnionitis. Proinflammatory cytokines, which are expressed more significantly in preterm neonates and chorioamnionitis, are associated with the presence of PDA. In this review, we focus on the pathogenesis of PDA in preterm infants and the role of biomarkers associated with the perinatal inflammatory process.
Collapse
|
9
|
Soullane S, Spence AR, Abenhaim HA. Association of placental pathology and gross morphology with autism spectrum disorders. Autism Res 2021; 15:531-538. [DOI: 10.1002/aur.2658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Revised: 12/07/2021] [Accepted: 12/09/2021] [Indexed: 11/09/2022]
Affiliation(s)
- Safiya Soullane
- Faculty of Medicine McGill University Montreal Quebec Canada
| | - Andrea R. Spence
- Centre for Clinical Epidemiology and Community Studies Jewish General Hospital Montreal Quebec Canada
| | - Haim A. Abenhaim
- Centre for Clinical Epidemiology and Community Studies Jewish General Hospital Montreal Quebec Canada
- Department of Obstetrics and Gynecology Jewish General Hospital, McGill University Montreal Quebec Canada
| |
Collapse
|
10
|
Intrapartum and Postpartum Management of Intra-amniotic Infection. Obstet Gynecol Surv 2021; 76:114-121. [PMID: 33625521 DOI: 10.1097/ogx.0000000000000867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Importance Intra-amniotic infection (IAI) is a common condition with potentially devastating maternal and neonatal complications. However, there are incomplete data regarding the most effective antimicrobial treatment regimen for this condition. Objective This article aims to review the current evidence and recommendations for intrapartum and postpartum management of IAI. Evidence Acquisition Original research articles, review articles, and guidelines on IAI were reviewed. Results Numerous known risk factors for IAI exist, some of which are modifiable. Serious neonatal complications can result from exposure to IAI including increased risk of preterm birth and neonatal death. Possible maternal complications include increased risk of cesarean delivery, postpartum hemorrhage, and postpartum endometritis. Antibiotics are the mainstay of treatment for IAI for both mothers and neonates, although there is no consensus on which antimicrobial agents are best and the appropriate duration of therapy. Conclusions and Relevance Monitoring patients for signs of IAI, proper treatment, and communication of the diagnosis with the pediatric team are essential for preventing maternal and neonatal complications of IAI. More research is needed to determine the proper treatment regimens for both mothers diagnosed with IAI and their neonates.
Collapse
|
11
|
A decade of neonatal sepsis caused by gram-negative bacilli-a retrospective matched cohort study. Eur J Clin Microbiol Infect Dis 2021; 40:1803-1813. [PMID: 33761020 PMCID: PMC8346411 DOI: 10.1007/s10096-021-04211-8] [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] [Received: 09/20/2020] [Accepted: 02/23/2021] [Indexed: 12/24/2022]
Abstract
This study is to determine the incidence and outcome of neonatal gram-negative bacilli (GNB) sepsis in Stockholm, Sweden, and describe bacterial characteristics. This is a retrospective cohort study. All infants with GNB-sepsis between 2006 and 2016 were included and matched with two control groups, with suspected sepsis and uninfected neonates, respectively. Outcome was death before discharge, risk of death within 5 days after sepsis onset, and morbidity. The resistance pattern from all GNB was collected, and all available isolates were subjected to genome typing. All neonates with GNB-sepsis (n = 107) were included, and the cumulative GNB-sepsis incidence was 0.35/1000 live born. The in-hospital mortality was 30/107 (28%). GNB late-onset sepsis (LOS) was associated with an increase in mortality before discharge compared to uninfected controls (OR = 3.9; CI 1.6–9.4) but not versus suspected sepsis. The suspected LOS cases did not statistically differ significantly from uninfected controls. The case fatality rate (CFR) at 5 days was 5/33 (15%) in GNB early-onset sepsis (EOS) and 25/74 (34%) in GNB-LOS. The adjusted hazard for 5 days CFR was higher in GNB-LOS versus uninfected controls (HR = 3.7; CI 1.2–11.2), but no significant difference was seen in GNB-LOS versus suspected sepsis or in suspected sepsis versus controls. ESBL production was seen in 7/107 (6.5%) of the GNB isolates. GNB-LOS was associated with a higher 5 days CFR and in-hospital mortality compared to uninfected controls but not versus suspect sepsis. The incidence of both GNB-EOS and GNB-LOS was lower than previously reported from comparable high-income settings. The occurrence of antibiotic resistance was low.
Collapse
|
12
|
Conde-Agudelo A, Romero R, Jung EJ, Garcia Sánchez ÁJ. Management of clinical chorioamnionitis: an evidence-based approach. Am J Obstet Gynecol 2020; 223:848-869. [PMID: 33007269 PMCID: PMC8315154 DOI: 10.1016/j.ajog.2020.09.044] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 09/08/2020] [Accepted: 09/24/2020] [Indexed: 02/09/2023]
Abstract
This review aimed to examine the existing evidence about interventions proposed for the treatment of clinical chorioamnionitis, with the goal of developing an evidence-based contemporary approach for the management of this condition. Most trials that assessed the use of antibiotics in clinical chorioamnionitis included patients with a gestational age of ≥34 weeks and in labor. The first-line antimicrobial regimen for the treatment of clinical chorioamnionitis is ampicillin combined with gentamicin, which should be initiated during the intrapartum period. In the event of a cesarean delivery, patients should receive clindamycin at the time of umbilical cord clamping. The administration of additional antibiotic therapy does not appear to be necessary after vaginal or cesarean delivery. However, if postdelivery antibiotics are prescribed, there is support for the administration of an additional dose. Patients can receive antipyretic agents, mainly acetaminophen, even though there is no clear evidence of their benefits. Current evidence suggests that the administration of antenatal corticosteroids for fetal lung maturation and of magnesium sulfate for fetal neuroprotection to patients with clinical chorioamnionitis between 24 0/7 and 33 6/7 weeks of gestation, and possibly between 23 0/7 and 23 6/7 weeks of gestation, has an overall beneficial effect on the infant. However, delivery should not be delayed to complete the full course of corticosteroids and magnesium sulfate. Once the diagnosis of clinical chorioamnionitis has been established, delivery should be considered, regardless of the gestational age. Vaginal delivery is the safer option and cesarean delivery should be reserved for standard obstetrical indications. The time interval between the diagnosis of clinical chorioamnionitis and delivery is not related to most adverse maternal and neonatal outcomes. Patients may require a higher dose of oxytocin to achieve adequate uterine activity or greater uterine activity to effect a given change in cervical dilation. The benefit of using continuous electronic fetal heart rate monitoring in these patients is unclear. We identified the following promising interventions for the management of clinical chorioamnionitis: (1) an antibiotic regimen including ceftriaxone, clarithromycin, and metronidazole that provides coverage against the most commonly identified microorganisms in patients with clinical chorioamnionitis; (2) vaginal cleansing with antiseptic solutions before cesarean delivery with the aim of decreasing the risk of endometritis and, possibly, postoperative wound infection; and (3) antenatal administration of N-acetylcysteine, an antioxidant and antiinflammatory agent, to reduce neonatal morbidity and mortality. Well-powered randomized controlled trials are needed to assess these interventions in patients with clinical chorioamnionitis.
Collapse
Affiliation(s)
- Agustin Conde-Agudelo
- 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, and U.S. Department of Health and Human Services, Bethesda, MD, and Detroit, MI; Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, MI
| | - 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, and U.S. Department of Health and Human Services, Bethesda, MD, and Detroit, MI; Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI; Department of Epidemiology and Biostatistics, Michigan State University, East Lansing, MI; Center for Molecular Medicine and Genetics, Wayne State University School of Medicine, Detroit, MI; Detroit Medical Center, Detroit, MI; Department of Obstetrics and Gynecology, Herbert Wertheim College of Medicine, Florida International University, Miami, FL.
| | - Eun Jung 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, and U.S. Department of Health and Human Services, Bethesda, MD, and Detroit, MI; Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, MI
| | - Ángel José Garcia Sánchez
- Department of Biomedical and Diagnostic Sciences, Faculty of Medicine, University of Salamanca, Salamanca, Spain
| |
Collapse
|
13
|
Miao J, Ren Z, Rao Y, Xia X, Wang J, Xu F, Zhang X, Yang J. Pathological staging of chorioamnionitis contributes to complications in preterm infants. Ital J Pediatr 2020; 46:127. [PMID: 32917243 PMCID: PMC7488745 DOI: 10.1186/s13052-020-00895-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Accepted: 09/02/2020] [Indexed: 11/22/2022] Open
Abstract
Objective To investigate the effect of pathological staging of chorioamnionitis (CA) on complications in preterm infants; Methods A single-center, retrospective study was conducted to choose singleton preterm infants (gestational age < 37 weeks) from the Department of Obstetrics and Gynecology in our hospital from December 2016 to December 2017. The basic data and placental pathological results were retrospectively collected. According to the placental pathological results of whether inflammation infiltrating amnion, CA 0/I phase was classified into non-amnionitis group, CA II/III phase was classified into amnionitis group, the incidence of common complications in preterm infants was compared. Further, logistic regression was used to analyze the effects of amnionitis on complications after being adjusted to gestational age, birth weight and thrombocytopenia. Results A total of 221 preterm infants were enrolled, including 186 cases in non-amnionitis group and 35 cases in amnionitis group. The gestational age of amnionitis group (32.00 ± 2.71 weeks) was significantly lower than non-amnionitis group (34.14 ± 2.06 weeks), birth weight (1.93 ± 0.64 kg) was significantly lower than that of non-amnionitis group (2.26 ± 0.58 kg), and the hospital stay in amnionitis group was significantly longer (25.71 ± 19.23 days), all of the difference above was statistically significant(P < 0.05). The incidence of intraventricular hemorrhage (IVH) in amnionitis group (37.14%) was significantly higher than that in non-amnionitis group (13.98%) (P = 0.002), and the risk of IVH was significantly increased by amnionitis (OR = 3.636, 95%CI: 1.632–8.102); after correction of gestational age, birth weight and thrombocytopenia, the risk of IVH was still significantly increased (OR = 2.471, P = 0.046, 95% CI: 1.015–6.015). And the late-onset IVH was more common (P = 0.009). Conclusion Amnionitis leads to a significant reduction in gestational age and birth weight in preterm infants, and it is an independent risk factor for IVH.
Collapse
Affiliation(s)
- Jiayu Miao
- Department of Neonatology, Guangdong Women and Children Hospital, Guangzhou, China
| | - Zhuxiao Ren
- Department of Neonatology, Guangdong Women and Children Hospital, Guangzhou, China
| | - Yunbei Rao
- Department of Neonatology, Guangzhou Medical University Second Affiliated Hospital, Guangzhou, China
| | - Xin Xia
- Department of Neonatology, Guangdong Women and Children Hospital, Guangzhou, China
| | - Jianlan Wang
- Department of Neonatology, Guangdong Women and Children Hospital, Guangzhou, China
| | - Fang Xu
- Department of Neonatology, Guangdong Women and Children Hospital, Guangzhou, China
| | - Xiaoling Zhang
- Department of Neonatology, Guangdong Women and Children Hospital, Guangzhou, China
| | - Jie Yang
- Department of Neonatology, Guangdong Women and Children Hospital, Guangzhou, China.
| |
Collapse
|
14
|
Perniciaro S, Casarin J, Nosetti L, Binda C, Salvatore S, Ghezzi F, Agosti M. Early- and Late-Respiratory Outcome in Very Low Birth Weight with or without Intrauterine Inflammation. Am J Perinatol 2020; 37:S76-S83. [PMID: 32898888 DOI: 10.1055/s-0040-1714257] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
UNLABELLED • IUI is a risk factor for spontaneous preterm birth and contributes to prematurity-associated mortality and morbidity.• HCA greatly affected Apgar's score and lung management of VLBWI at birth and later on with increased incidence of BPD.• HCA + FUN did not significantly impact on respiratory outcome. OBJECTIVE Intrauterine inflammation or infection (IUI) is a risk factor for spontaneous preterm birth and contributes to prematurity-associated mortality and morbidity. IUI can include inflammation, as well as infections of varying degrees of severity and duration. Histological chorioamnionitis (HCA) remains the "gold standard" for the diagnosis but clinical, microbiological, and biochemical criteria are often used to define chorioamnionitis. The impact of intrauterine inflammation on respiratory outcome, in infants with very low birth weight, is still unclear and previous data are conflicting showing increase, decrease, or no risk of respiratory complications. STUDY DESIGN This is a retrospective study aimed to investigate the role of IUI on neonatal respiratory outcome. Histological criteria (HCA alone and HCA + funisitis [FUN]) and "intrauterine inflammation or infection or both" "Triple I" definition were used; different management in delivery room, in the first 7 days of life (early outcome) and incidence of mild, moderate, and severe bronchopulmonary dysplasia (BPD; late outcome) were considered. RESULTS A total of 162 infants with very low birth weight (VLBW) with placenta histology were enrolled. Suspected TRIPLE or fever alone was present in 7.4%, and confirmed TRIPLE or HCA in 29.6% of cases (HCA alone 19.1% vs. HCA + FUN 10.5%). Preterm premature rupture of membrane (p-PROM) was strongly associated with HCA (66.6% in HCA group) and HCA was present in 80% neonates born between 22 and 24 weeks of gestational age (GA). HCA group (GA, 26 weeks; birth weight [BW], 880 g) showed lower Apgar's score, higher intubation rate, and need of ventilation in delivery room, surfactant, duration of noninvasive ventilation (NIV), severe patent ductus arteriosus (PDA), and incidence of BPD compared with no-HCA (GA, 30 weeks; BW, 1,210 g). Length of hospital stay and mortality were higher in HCA group (p = 0.01) and an increasing trend was present for HCA + FUN compared with HCA alone. CONCLUSION HCA greatly affected Apgar's score and lung management of VLBW infants (VLBWI) at birth and later on with increased incidence of BPD, thus impacting length of stay and quality of life, while HCA + FUN did not significantly impact on respiratory outcome. Further studies are needed to clarify the role of HCA and FUN in VLBW neonates.
Collapse
Affiliation(s)
- Simona Perniciaro
- Department of Neonatology, Neonatal Intensive care Unit and Pediatrics, "Filippo Del Ponte" Hospital, University of Insubria, Varese, Italy
| | - Jvan Casarin
- Department of Obstetrics and Gynecology, "Filippo Del Ponte" Hospital, University of Insubria, Varese, Italy
| | - Luana Nosetti
- Department of Neonatology, Neonatal Intensive care Unit and Pediatrics, "Filippo Del Ponte" Hospital, University of Insubria, Varese, Italy
| | - Chiara Binda
- Department of Neonatology, Neonatal Intensive care Unit and Pediatrics, "Filippo Del Ponte" Hospital, University of Insubria, Varese, Italy
| | - Silvia Salvatore
- Department of Neonatology, Neonatal Intensive care Unit and Pediatrics, "Filippo Del Ponte" Hospital, University of Insubria, Varese, Italy
| | - Fabio Ghezzi
- Department of Obstetrics and Gynecology, "Filippo Del Ponte" Hospital, University of Insubria, Varese, Italy
| | - Massimo Agosti
- Department of Neonatology, Neonatal Intensive care Unit and Pediatrics, "Filippo Del Ponte" Hospital, University of Insubria, Varese, Italy
| |
Collapse
|
15
|
Supriya, Singh S, Tripathi S, Kumar M. Outcome of preterm neonates born to women of a developing country at risk of preterm birth exposed to varying doses of antenatal corticosteroid: A prospective observational study. CLINICAL EPIDEMIOLOGY AND GLOBAL HEALTH 2020. [DOI: 10.1016/j.cegh.2019.12.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
|
16
|
Wynne K, Rowe C, Delbridge M, Watkins B, Brown K, Addley J, Woods A, Murray H. Antenatal corticosteroid administration for foetal lung maturation. F1000Res 2020; 9. [PMID: 32269758 PMCID: PMC7111495 DOI: 10.12688/f1000research.20550.1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/23/2020] [Indexed: 01/27/2023] Open
Abstract
Antenatal corticosteroids are an essential component in the management of women at risk for preterm labour. They promote lung maturation and reduce the risk of other preterm neonatal complications. This narrative review discusses the contentious issues and controversies around the optimal use of antenatal corticosteroids and their consequences for both the mother and the neonate. The most recent evidence base is presented.
Collapse
Affiliation(s)
- Katie Wynne
- Department of Diabetes & Endocrinology, John Hunter Hospital, New Lambton Heights, NSW, 2305, Australia.,Mothers and Babies, Hunter Medical Research Institute, New Lambton Heights, NSW, 2305, Australia.,School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, 2308, Australia
| | - Christopher Rowe
- Department of Diabetes & Endocrinology, John Hunter Hospital, New Lambton Heights, NSW, 2305, Australia.,Mothers and Babies, Hunter Medical Research Institute, New Lambton Heights, NSW, 2305, Australia.,School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, 2308, Australia
| | - Matthew Delbridge
- School of Medicine and Public Health, University of New England, Armidale, NSW, 2351, Australia
| | - Brendan Watkins
- School of Medicine and Public Health, University of New England, Armidale, NSW, 2351, Australia
| | - Karina Brown
- School of Medicine and Public Health, University of New England, Armidale, NSW, 2351, Australia
| | - Jordan Addley
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, 2308, Australia
| | - Andrew Woods
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, 2308, Australia.,Department of Obstetrics, John Hunter Hospital, New Lambton Heights, NSW, 2305, Australia
| | - Henry Murray
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, 2308, Australia.,Department of Obstetrics, John Hunter Hospital, New Lambton Heights, NSW, 2305, Australia
| |
Collapse
|
17
|
Lee HS, Kim SY. Histological chorioamnionitis, antenatal steroids, and neonatal outcomes in very low birth weight infants: A nationwide study. PLoS One 2019; 14:e0224450. [PMID: 31661511 PMCID: PMC6818766 DOI: 10.1371/journal.pone.0224450] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2019] [Accepted: 10/14/2019] [Indexed: 12/22/2022] Open
Abstract
Background The aim of this study was to investigate whether some associations between histological chorioamnionitis (HCA) and favorable neonatal outcomes might be linked to those of antenatal steroids (AS) by determining the separate as well as the combined associations of HCA and AS with neonatal outcomes in very low birth weight infants (VLBWIs). Methods This was a population-based study of VLBWIs born at 20–33 weeks’ gestation between January 2013 and December 2015 from the Korean Neonatal Network. A total of 4652 VLBWIs were enrolled for prevalence study. Of these, 2900 singleton VLBWIs were used for outcome analyses to evaluate individual associations of HCA and AS simultaneously with correction for potential perinatal factors and an interaction term of HCA and AS. Results The overall prevalence of HCA was 34.9% (1623 VLBWIs). Multivariable logistic regression demonstrated that HCA was associated with decreased mortality (adjusted odds ratio [aOR], 0.51; 95% confidence interval [CI], 0.29–0.91; P = 0.022), AS were associated with reduction in mortality (aOR, 0.59; 95% CI, 0.39–0.90; P = 0.014) and neonatal seizure (aOR, 0.57; 95% CI, 0.37–0.86; P = 0.008), and a combination of HCA and AS was associated with remarkably lowered severe intraventricular hemorrhage by interacting with each other (aOR, 0.47; 95% CI, 0.25–0.88; P = 0.019). Conclusions We suggest that in VLBWIs HCA and AS may be favorable independent factors for neonatal outcome and may also work in synergy for neuroprotection.
Collapse
Affiliation(s)
- Hyun-Seung Lee
- Department of Pediatrics, CHA Gangnam Medical Center, CHA University School of Medicine, Seoul, Korea
| | - So Young Kim
- Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul, Korea
- * E-mail:
| |
Collapse
|
18
|
Thomson AJ. Care of Women Presenting with Suspected Preterm Prelabour Rupture of Membranes from 24 +0 Weeks of Gestation: Green-top Guideline No. 73. BJOG 2019; 126:e152-e166. [PMID: 31207667 DOI: 10.1111/1471-0528.15803] [Citation(s) in RCA: 78] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
19
|
Ylijoki MK, Ekholm E, Ekblad M, Lehtonen L. Prenatal Risk Factors for Adverse Developmental Outcome in Preterm Infants-Systematic Review. Front Psychol 2019; 10:595. [PMID: 30971974 PMCID: PMC6445261 DOI: 10.3389/fpsyg.2019.00595] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Accepted: 03/04/2019] [Indexed: 11/13/2022] Open
Abstract
Background: Preterm infants are still at an increased risk for suboptimal neurodevelopmental outcomes when compared with term born infants. The development of a child born preterm can be jeopardized by suboptimal conditions during pregnancy, in addition to the suboptimal growth environment postnatally compared to the normal in utero environment. This review summarizes the literature on the role of chorioamnionitis, placental insufficiency, and maternal smoking on the developmental outcomes of preterm infants. Methods: A systematic database search was performed to identify all original articles published on or before September 12, 2018 that evaluated the impact of clinical or histological chorioamnionitis, abnormal prenatal fetal and placental blood flow, and prenatal smoking exposure on the neuropsychological and cognitive outcomes of preterm infants. We identified a total of 54 studies. Thirty five original articles evaluated the effects of clinical or histological chorioamnionitis; 15 studies evaluated the effects of abnormal blood flow patterns; and four studies evaluated the effects of maternal smoking during pregnancy. Results: The studies on prenatal risk factors showed conflicting results about the impact on the neurodevelopment of preterm infants. The majority of the studies did not show that chorioamnionitis poses a direct risk to the development of preterm infants. The role of abnormal prenatal placental and fetal blood flow on the development of preterm infants remained inconclusive because the sample sizes were often small and methodological problems complicated the interpretation of the data. Maternal smoking during pregnancy was assessed only in one cohort which showed that maternal smoking is a risk for suboptimal cognitive and neuropsychological development in preterm infants. Conclusions: This review summarizes the data on several prenatal risk factors which play a role in the developmental outcomes of preterm infants. To optimize the developmental outcomes, we need to first optimize the fetal wellbeing before birth. More research that extends from the fetal life to long-term developmental outcomes is needed.
Collapse
Affiliation(s)
- Milla K Ylijoki
- Department of Paediatrics and Adolescent Medicine, Turku University Hospital, University of Turku, Turku, Finland.,Department of Paediatric Neurology, Turku University Hospital, University of Turku, Turku, Finland
| | - Eeva Ekholm
- Department of Obstetrics and Gynaecology, Turku University Hospital, University of Turku, Turku, Finland
| | - Mikael Ekblad
- Department of Human Development and Family Studies, Purdue University, West Lafayette, IN, United States.,Department of General Practice, Turku University Hospital, Turku University, Turku, Finland
| | - Liisa Lehtonen
- Department of Paediatrics and Adolescent Medicine, Turku University Hospital, University of Turku, Turku, Finland
| |
Collapse
|
20
|
Pietrasanta C, Pugni L, Merlo D, Acaia B, Consonni D, Ronchi A, Ossola MW, Ghirardi B, Bottino I, Cribiù FM, Bosari S, Mosca F. Impact of different stages of intrauterine inflammation on outcome of preterm neonates: Gestational age-dependent and -independent effect. PLoS One 2019; 14:e0211484. [PMID: 30735531 PMCID: PMC6368287 DOI: 10.1371/journal.pone.0211484] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Accepted: 01/15/2019] [Indexed: 01/08/2023] Open
Abstract
Objective To investigate the impact of different stages of intrauterine inflammation (IUI) on neonatal outcomes, before and after adjusting for gestational age (GA) and other perinatal confounders. Methods This was an observational, prospective, single-center cohort study including all eligible neonates with GA < 35 weeks and/or birth weight ≤ 1500 g born at a 3rd level Neonatal Intensive Care Unit between 2011 and 2014. Pathological patterns of placenta, membranes and cord were classified according to Redline’s criteria. Multivariable linear and logistic regression models were applied, either including or not GA among the covariates. Results Of the 807 enrolled neonates, 134 (16.6%) had signs of IUI: among these, 54.5% showed just histological chorioamnionitis (HCA), 25.4% had HCA + funisitis (FUN) stage 1, and 20.1% had HCA + FUN stage 2–3. At univariate analysis, HCA increased the risk for retinopathy of prematurity (ROP) and bronchopulmonary dysplasia, while FUN (any stage) had a deleterious impact on all outcomes investigated. After adjustment for covariates not including GA, HCA was a risk factor only for ROP (OR = 2.8, CI: 1–7.8), while FUN (any stage) was still associated with increased ORs for all outcomes (p <0.01). Upon inclusion of GA in the regression model, the results differed remarkably. HCA was associated with lower risk for mechanical ventilation (OR = 0.3, CI: 0.1–0.7) and need for surfactant (OR = 0.5, CI: 0.2–0.9), while FUN (any stage) worsened clinical conditions at birth (p <0.05), increased the risk for early-onset sepsis (p <0.01), and increased the length of mechanical ventilation (FUN stage 2–3 only, RC = 6.5 days, CI: 2–11). No other outcome was affected. Conclusions IUI, especially FUN, negatively impact most neonatal morbidities, but its effect is partially reverted adjusting for GA. Considered that GA is an intermediate variable interposed between prenatal causes of prematurity and outcomes, the appropriateness of adjusting for GA may be questionable.
Collapse
Affiliation(s)
- Carlo Pietrasanta
- NICU Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
- University of Milan, Department of Clinical Sciences and Community Health, Milan, Italy
| | - Lorenza Pugni
- NICU Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
- * E-mail:
| | - Daniela Merlo
- Pathology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Barbara Acaia
- Gynecology and Obstetrics Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Dario Consonni
- Epidemiology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Andrea Ronchi
- NICU Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Manuela Wally Ossola
- Gynecology and Obstetrics Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Beatrice Ghirardi
- NICU Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
- University of Milan, Department of Clinical Sciences and Community Health, Milan, Italy
| | - Ilaria Bottino
- NICU Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
- University of Milan, Department of Clinical Sciences and Community Health, Milan, Italy
| | - Fulvia Milena Cribiù
- Pathology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Silvano Bosari
- Pathology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- University of Milan, Department of Pathophysiology and Transplantation, Milan, Italy
| | - Fabio Mosca
- NICU Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
- University of Milan, Department of Clinical Sciences and Community Health, Milan, Italy
| |
Collapse
|
21
|
Ryu YH, Oh S, Sohn J, Lee J. The Associations between Antenatal Corticosteroids and In-Hospital Outcomes of Preterm Singleton Appropriate for Gestational Age Neonates according to the Presence of Maternal Histologic Chorioamnionitis. Neonatology 2019; 116:369-375. [PMID: 31593959 DOI: 10.1159/000502650] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2019] [Accepted: 08/12/2019] [Indexed: 11/19/2022]
Abstract
INTRODUCTION This study aimed to assess the association between antenatal corticosteroid (ACS) and in-hospital outcomes of preterm singleton appropriate for gestational age (AGA) infants according to the presence of maternal histologic chorioamnionitis (HCA). METHODS A retrospective study was performed with singleton AGA neonates of 23+0 to 33+6 weeks' gestation born between 2007 and 2014. We compared the clinical outcomes according to the presence of HCA and ACS use. We also divided the ACS group into 2 groups: infants who received ACS 2-7 days before birth (optimal ACS) or not (suboptimal ACS). Multivariate logistic regression with Firth's penalized likelihood was performed. RESULTS In total, 254 neonates were eligible with 109 neonates with HCA (42.9%). In multivariate analysis adjusting for GA, sex, and cesarean section, ACS use was associated with reduced severe bronchopulmonary dysplasia (BPD) or death and hypotension within 7 postnatal days among the neonates with HCA. However, it was associated with increased patent ductus arteriosus (PDA) treatment. In the optimal ACS group, severe BPD or death (aOR 0.03, 95% CI 0.01-0.42), hypotension (aOR 0.02, 95% CI 0.01-0.26), and inhaled nitric oxide use (aOR 0.06, 95% CI 0.00-0.81) were lower, however, PDA treatment (aOR 8.14, 95% CI 1.20-55.24) and sepsis (aOR 6.85, 95% CI 1.02-46.07) were higher when compared with the no ACS group among HCA+ infants. Among HCA- infants, only PDA treatment was lower in the ACS group. CONCLUSION In neonates with HCA, ACS treatment was associated with reduced morbidities. However, increased sepsis was associated with optimal ACS use.
Collapse
Affiliation(s)
- Young Hye Ryu
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Sohee Oh
- Department of Biostatistics, SMG-SNU Boramae Medical Center, Seoul, Republic of Korea
| | - Jin Sohn
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Republic of Korea.,Department of Pediatrics, SMG-SNU Boramae Medical Center, Seoul, Republic of Korea
| | - Jin Lee
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Republic of Korea, .,Department of Pediatrics, SMG-SNU Boramae Medical Center, Seoul, Republic of Korea,
| |
Collapse
|
22
|
Lorthe E. [Epidemiology, risk factors and child prognosis: CNGOF Preterm Premature Rupture of Membranes Guidelines]. ACTA ACUST UNITED AC 2018; 46:1004-1021. [PMID: 30385352 DOI: 10.1016/j.gofs.2018.10.019] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Indexed: 12/18/2022]
Abstract
OBJECTIVES To synthetize the available evidence regarding the incidence and risk factors of preterm premature rupture of membranes (PPROM). To describe the evolution of pregnancy, neonatal outcomes and the prognosis of infants born in a context of PPROM, according to the existence of an associated intrauterine infection and to the latency duration. METHOD Consultation of the Medline database, from 1980 to February 2018. RESULTS PPROM before 37 and before 34 weeks' gestation occur in 2-3% and <1% of pregnancies, respectively (LE2). Although many risk factors are identified, few are modifiable, and the vast majority of patients have no risk factors (LE2). Consequently, individual prediction of the risk of PPROM and primary prevention measures have not been shown to be effective and are not recommended in clinical practice (Grade B). Most women give birth within the week following PPROM (LE2). The main complications of PPROM are prematurity, intrauterine infection and obstetric and maternal complications (LE2). Latency duration and the frequency of complications decrease with increasing gestational age at PPROM (LE2). Neonatal prognosis is largely conditioned by gestational age at birth, with no apparent over-risk of poor outcomes linked to PPROM compared to other causes of preterm birth (LE2). In contrast, intrauterine infection is associated with an increased risk of in utero fetal death (LE3), necrotizing enterocolitis (LE1) and early-onset sepsis (LE2). The association of intrauterine infection with neurological morbidity remains controversial. Prolongation of latency, from gestational age at PPROM, is beneficial for the child (LE2). CONCLUSION PPROM is a major cause of prematurity and short- and long-term mortality and morbidity. Antenatal care is an important issue for obstetric and pediatric teams, aiming to reduce complications and adverse consequences for both mother and child.
Collapse
Affiliation(s)
- E Lorthe
- Inserm UMR 1153, obstetrical, perinatal and pediatric epidemiology research team (Épopé), Center for epidemiology and statistics Sorbonne Paris Cité, département hospitalo-universitaire risks in pregnancy, Paris Descartes university, 75000 Paris, France; EPI unit - institute of public health, university of Porto, rua das Taipas n(o) 135, 4050-600 Porto, Portugal.
| |
Collapse
|
23
|
Abstract
Antenatal corticosteroids remain one of the crucial interventions in those at risk for imminent preterm birth. Therapeutic benefits include reducing major complications of prematurity such as respiratory distress syndrome, intraventricular hemorrhage, and necrotizing enterocolitis, as well as an overall decrease in neonatal deaths. Optimal reductions in neonatal morbidity and mortality require a thoughtful review of the timing of administration. In addition, a thorough understanding is required of which patients maximally benefit from this intervention in the management and counseling of those at risk for preterm birth.
Collapse
Affiliation(s)
- Whitney A Booker
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, College of Physicians and Surgeons, Columbia University Medical Center, 622 West 168th Street, PH 16-66, New York, NY 10032, USA.
| | - Cynthia Gyamfi-Bannerman
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, College of Physicians and Surgeons, Columbia University Medical Center, 622 West 168th Street, PH 16-66, New York, NY 10032, USA
| |
Collapse
|
24
|
Grisaru-Granovsky S, Boyko V, Lerner-Geva L, Hammerman C, Rottenstreich M, Samueloff A, Schimmel MS, Reichman B. The mortality of very low birth weight infants: the benefit and relative impact of changes in population and therapeutic variables. J Matern Fetal Neonatal Med 2018; 32:2443-2451. [DOI: 10.1080/14767058.2018.1438398] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Sorina Grisaru-Granovsky
- Department of Obstetrics and Gynecology, Shaare Zedek Medical Center, affiliated with the Hebrew University Medical School of Jerusalem, Jerusalem, Israel
| | - Valentina Boyko
- Department of Obstetrics and Gynecology, Shaare Zedek Medical Center, affiliated with the Hebrew University Medical School of Jerusalem, Jerusalem, Israel
| | - Liat Lerner-Geva
- Department of Obstetrics and Gynecology, Shaare Zedek Medical Center, affiliated with the Hebrew University Medical School of Jerusalem, Jerusalem, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Cathy Hammerman
- Department of Neonatology, Shaare Zedek Medical Center, affiliated with the Hebrew University Medical School of Jerusalem, Jerusalem, Israel
| | - Misgav Rottenstreich
- Department of Obstetrics and Gynecology, Shaare Zedek Medical Center, affiliated with the Hebrew University Medical School of Jerusalem, Jerusalem, Israel
| | - Arnon Samueloff
- Department of Obstetrics and Gynecology, Shaare Zedek Medical Center, affiliated with the Hebrew University Medical School of Jerusalem, Jerusalem, Israel
| | - Michael S. Schimmel
- Department of Neonatology, Shaare Zedek Medical Center, affiliated with the Hebrew University Medical School of Jerusalem, Jerusalem, Israel
| | - Brian Reichman
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
- Women & Children’s Health Research Unit, Gertner Institute, Tel Hashomer, Israel
| | | |
Collapse
|
25
|
Moss TJM, Westover AJ. Inflammation-induced preterm lung maturation: lessons from animal experimentation. Paediatr Respir Rev 2017; 23:72-77. [PMID: 27856214 DOI: 10.1016/j.prrv.2016.10.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2015] [Revised: 07/08/2016] [Accepted: 10/05/2016] [Indexed: 02/05/2023]
Abstract
Intrauterine inflammation, or chorioamnionitis, is a major contributor to preterm birth. Prematurity per se is associated with considerable morbidity and mortality resulting from lung immaturity but exposure to chorioamnionitis reduces the risk of neonatal respiratory distress syndrome (RDS) in preterm infants. Animal experiments have identified that an increase in pulmonary surfactant production by the preterm lungs likely underlies this decreased risk of RDS in infants exposed to chorioamnionitis. Further animal experimentation has shown that infectious or inflammatory agents in amniotic fluid exert their effects on lung development by direct effects within the developing respiratory tract, and probably not by systemic pathways. Differences in the effects of intrauterine inflammation and glucocorticoids demonstrate that canonical glucocorticoid-mediated lung maturation is not responsible for inflammation-induced changes in lung development. Animal experimentation is identifying alternative lung maturational pathways, and transgenic animals and cell culture techniques will allow identification of novel mechanisms of lung maturation that may lead to new treatments for the prevention of RDS.
Collapse
Affiliation(s)
- Timothy J M Moss
- The Ritchie Centre, Hudson Institute of Medical Research, Clayton, VIC 3168, Australia; Department of Obstetrics and Gynecology, Monash University, Clayton, VIC 3168, Australia.
| | - Alana J Westover
- The Ritchie Centre, Hudson Institute of Medical Research, Clayton, VIC 3168, Australia
| |
Collapse
|
26
|
Leading causes of preterm delivery as risk factors for intraventricular hemorrhage in very preterm infants: results of the EPIPAGE 2 cohort study. Am J Obstet Gynecol 2017; 216:518.e1-518.e12. [PMID: 28104401 DOI: 10.1016/j.ajog.2017.01.002] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2016] [Revised: 01/04/2017] [Accepted: 01/09/2017] [Indexed: 12/21/2022]
Abstract
BACKGROUND Intraventricular hemorrhage is a major risk factor for neurodevelopmental disabilities in preterm infants. However, few studies have investigated how pregnancy complications responsible for preterm delivery are related to intraventricular hemorrhage. OBJECTIVE We sought to investigate the association between the main causes of preterm delivery and intraventricular hemorrhage in very preterm infants born in France during 2011 between 22-31 weeks of gestation. STUDY DESIGN The study included 3495 preterm infants from the national EPIPAGE 2 cohort study who were admitted to neonatal intensive care units and had at least 1 cranial ultrasound assessment. The primary outcome was grade I-IV intraventricular hemorrhage according to the Papile classification. Multinomial logistic regression models were used to study the relationship between risk of intraventricular hemorrhage and the leading causes of preterm delivery: vascular placental diseases, isolated intrauterine growth retardation, placental abruption, preterm labor, and premature rupture of membranes, with or without associated maternal inflammatory syndrome. RESULTS The overall frequency of grade IV, III, II, and I intraventricular hemorrhage was 3.8% (95% confidence interval, 3.2-4.5), 3.3% (95% confidence interval, 2.7-3.9), 12.1% (95% confidence interval, 11.0-13.3), and 17.0% (95% confidence interval, 15.7-18.4), respectively. After adjustment for gestational age, antenatal magnesium sulfate therapy, level of care in the maternity unit, antenatal corticosteroids, and chest compressions, infants born after placental abruption had a higher risk of grade IV and III intraventricular hemorrhage compared to those born under placental vascular disease conditions, with adjusted odds ratios of 4.3 (95% confidence interval, 1.1-17.0) and 4.4 (95% confidence interval, 1.1-17.6), respectively. Similarly, preterm labor with concurrent inflammatory syndrome was associated with an increased risk of grade IV intraventricular hemorrhage (adjusted odds ratio, 3.4; 95% confidence interval, 1.1-10.2]). Premature rupture of membranes did not significantly increase the risk. CONCLUSION Relationships between the causes of preterm birth and intraventricular hemorrhage were limited to specific and rare cases involving acute hypoxia-ischemia and/or inflammation. While the emergent nature of placental abruption would challenge any attempts to optimize management, the prenatal care offered during preterm labor could be improved.
Collapse
|
27
|
Magann EF, Haram K, Ounpraseuth S, Mortensen JH, Spencer HJ, Morrison JC. Use of antenatal corticosteroids in special circumstances: a comprehensive review. Acta Obstet Gynecol Scand 2017; 96:395-409. [DOI: 10.1111/aogs.13104] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2016] [Accepted: 01/20/2017] [Indexed: 11/28/2022]
Affiliation(s)
- Everett F. Magann
- Department of Obstetrics and Gynecology; Department of Biostatistics; University of Arkansas for the Medical Sciences; Little Rock AR USA
| | - Kjell Haram
- Haukeland University Hospital; Department of Public and Primary Care; University of Bergen; Bergen Norway
| | - Songthip Ounpraseuth
- Department of Obstetrics and Gynecology; Department of Biostatistics; University of Arkansas for the Medical Sciences; Little Rock AR USA
| | - Jan H. Mortensen
- Haukeland University Hospital; Department of Public and Primary Care; University of Bergen; Bergen Norway
| | - Horace J. Spencer
- Haukeland University Hospital; Department of Public and Primary Care; University of Bergen; Bergen Norway
| | - John C. Morrison
- Department of Obstetrics and Gynecology; University of Mississippi Medical Center; Jackson MS USA
| |
Collapse
|
28
|
Hütten MC, Wolfs TGAM, Kramer BW. Can the preterm lung recover from perinatal stress? Mol Cell Pediatr 2016; 3:15. [PMID: 27075524 PMCID: PMC4830776 DOI: 10.1186/s40348-016-0043-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2015] [Accepted: 03/22/2016] [Indexed: 11/10/2022] Open
Abstract
After birth, adequate lung function is necessary for the successful adaptation of a preterm baby. Both prenatal and postnatal insults and therapeutic interventions have an immediate effect on lung function and gas exchange but also interfere with fetal and neonatal lung development. Prenatal insults like chorioamnionitis and prenatal interventions like maternal glucocorticosteroids interact but might also determine the preterm baby's lung response to postnatal interventions ("second hit") like supplementation of oxygen and drug therapy. We review current experimental and clinical findings on the influence of different perinatal factors on preterm lung development and discuss how well-established interventions in neonatal care might be adapted to attenuate postnatal lung injury.
Collapse
Affiliation(s)
- Matthias C Hütten
- Neonatology, Department of Pediatrics, Maastricht University Medical Center, Maastricht, Netherlands.,Neonatology, Department of Pediatrics, Aachen University Hospital, Aachen, Germany.,Neonatology, Department of Pediatrics, Würzburg University Hospital, Würzburg, Germany.,Faculty of Health, Medicine and Lifesciences, School for Oncology and Developmental Biology, Maastricht University, Maastricht, The Netherlands
| | - Tim G A M Wolfs
- Neonatology, Department of Pediatrics, Maastricht University Medical Center, Maastricht, Netherlands.,Faculty of Health, Medicine and Lifesciences, School for Oncology and Developmental Biology, Maastricht University, Maastricht, The Netherlands
| | - Boris W Kramer
- Neonatology, Department of Pediatrics, Maastricht University Medical Center, Maastricht, Netherlands. .,Faculty of Health, Medicine and Lifesciences, School for Oncology and Developmental Biology, Maastricht University, Maastricht, The Netherlands.
| |
Collapse
|
29
|
Amiya RM, Mlunde LB, Ota E, Swa T, Oladapo OT, Mori R. Antenatal Corticosteroids for Reducing Adverse Maternal and Child Outcomes in Special Populations of Women at Risk of Imminent Preterm Birth: A Systematic Review and Meta-Analysis. PLoS One 2016; 11:e0147604. [PMID: 26841022 PMCID: PMC4740425 DOI: 10.1371/journal.pone.0147604] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2015] [Accepted: 01/06/2016] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND This study synthesizes available evidence on antenatal corticosteroids (ACS) use among special subgroups of women at risk of imminent preterm birth, including those (1) with pregestational and gestational diabetes mellitus, (2) undergoing elective caesarean section (CS) in late preterm (34 to<37 weeks), (3) with chorioamnionitis, and (4) with growth-restricted fetuses. METHODS A systematic search of MEDLINE, EMBASE, CINAHL, Cochrane Library, POPLINE, and World Health Organization Regional Databases was conducted for all comparative studies. Two reviewers independently determined study eligibility, extracted data, and assessed study quality. Pooled mean differences and odds ratios with 95% confidence intervals were estimated from available data, based on fixed- and random-effects models, as appropriate. RESULTS No eligible studies were identified for ACS use in diabetic pregnant women or those undergoing elective CS at late preterm. Nine studies each on ACS use in women with chorioamnionitis and in women with fetal growth restriction met inclusion criteria; eight studies were separately included in the meta-analyses for the two subpopulations. For ACS administration in women with chorioamnionitis, pooled analyses showed reductions in neonatal mortality (OR: 0.49, 95% CI: 0.34-0.73), respiratory distress syndrome (OR: 0.58, 95% CI: 0.44-0.76), intraventricular haemorrhage (OR: 0.41, 95% CI: 0.24-0.69), and severe intraventricular haemorrhage (OR: 0.40, 95% CI: 0.24-0.69). Maternal and long-term newborn outcomes were not reported. Effects of ACS use were inconclusive for cases with fetal growth restriction. CONCLUSION Direct evidence on the effectiveness and safety of ACS is lacking for diabetic pregnant women at risk of preterm birth and those undergoing elective late-preterm CS, though this does not necessarily recommend against their use in diabetic women. While evidence remains inconclusive for women with growth-restricted preterm neonates, ACS appears to benefit preterm neonates delivered by women with chorioamnionitis. High-quality studies on maternal and long-term child outcomes in more diverse settings are needed to establish the balance of potential harms versus benefits in using ACS for these understudied subgroups.
Collapse
Affiliation(s)
- Rachel M. Amiya
- Department of Health Policy, National Center for Child Health and Development, Tokyo, Japan
- Department of Family Nursing, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Linda B. Mlunde
- Department of Community and Global Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Erika Ota
- Department of Health Policy, National Center for Child Health and Development, Tokyo, Japan
- * E-mail:
| | - Toshiyuki Swa
- Graduate School of Human Sciences, Osaka University, Suita, Japan
| | - Olufemi T. Oladapo
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Rintaro Mori
- Department of Health Policy, National Center for Child Health and Development, Tokyo, Japan
| |
Collapse
|
30
|
Ylijoki M, Lehtonen L, Lind A, Ekholm E, Lapinleimu H, Kujari H, Haataja L. Chorioamnionitis and Five-Year Neurodevelopmental Outcome in Preterm Infants. Neonatology 2016; 110:286-295. [PMID: 27355828 DOI: 10.1159/000446236] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2015] [Accepted: 04/18/2016] [Indexed: 11/19/2022]
Abstract
BACKGROUND Chorioamnionitis, a risk factor for preterm delivery, has been suggested to be associated with suboptimal neurological development in premature infants. OBJECTIVE To evaluate the association between chorioamnionitis and neurodevelopment in preterm infants at 5 years of age. Methods Very low birth weight and very low gestational age infants (n = 197) were recruited. Placental samples (n = 117) were evaluated for histological chorioamnionitis. Fetal histological chorioamnionitis was analyzed as a subgroup. The diagnosis of clinical chorioamnionitis was derived from medical records. Neurodevelopmental impairments were evaluated at 2 years of age, and cognitive development (n = 188) and neuropsychological performance (n = 193) were evaluated at 5 years of age. RESULTS There were no associations between histological or clinical chorioamnionitis and neurodevelopmental impairments at 2 years of age. Clinical chorioamnionitis and fetal histological chorioamnionitis were not associated with cognitive development or neuropsychological performance, but histological chorioamnionitis was associated with poorer cognitive outcome (regression coefficient = -7.22, 95% CI: -14.31 to -0.13) and weaker memory and learning functions (regression coefficient = -1.29, 95% CI: -2.40 to -0.18) at 5 years of age. CONCLUSION Our study findings do not support clinical chorioamnionitis having a major independent role in the pathogenesis of neurodevelopmental problems in very preterm infants. Histological chorioamnionitis was associated with slightly less optimal performance at 5 years of age, but further studies are needed to verify the clinical significance of these findings.
Collapse
Affiliation(s)
- Milla Ylijoki
- Department of Paediatrics and Adolescent Medicine, Turku University and Turku University Hospital, Turku, Finland
| | | | | | | | | | | | | | | |
Collapse
|
31
|
Chorioamnionitis and Patent Ductus Arteriosus: A Systematic Review and Meta-Analysis. PLoS One 2015; 10:e0138114. [PMID: 26375582 PMCID: PMC4574167 DOI: 10.1371/journal.pone.0138114] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2015] [Accepted: 08/25/2015] [Indexed: 01/24/2023] Open
Abstract
Background Chorioamnionitis has recently been reported as a risk factor for various neonatal diseases, including cerebral palsy, bronchopulmonary dysplasia, and necrotizing enterocolitis, but its effect on patent ductus arteriosus (PDA) is unclear. We performed a systematic review and meta-analysis to evaluate the effect of chorioamnionitis on PDA. Methods We searched PubMed, EMBASE, Cochrane Library, and KoreaMed databases using the terms: “intrauterine infection” or “maternal infection” or “antenatal infection” or “chorioamnionitis” or “placenta inflammation” or “placenta pathology” or “neonatal outcome” or “neonatal morbidity” or “PDA or patent ductus arteriosus” or “ductus arteriosus,” and “prematurity” or “very low birth weight infant.” Studies were included if they were randomized controlled trials, case–control studies, or cohort studies that included information relating to chorioamnionitis and PDA. Results Among 1,571 studies, a total of 23 studies (17,708 cases) were included in the meta-analysis to analyze the relationship between chorioamnionitis and PDA, except one study that only included PDA requiring surgical ligation. The association between chorioamnionitis and PDA was statistically significant (odds ratio [OR] 1.43; 95% confidence interval [CI] 1.19, 1.72; P < 0.0001). In subgroup analysis, clinical chorioamnionitis was not associated with PDA (OR 1.28; 95% CI 1.00, 1.64, 1.790; P = 0.05), whereas histologic chorioamnionitis (OR 1.54; 95% CI 1.10, 2.15; P = 0.01) and chorioamnionitis diagnosed from both clinical and histologic findings (OR 1.75; 95% CI 1.07, 2.86; P = 0.03) showed significant associations with PDA. Chorioamnionitis did not increase the risk of PDA requiring surgical ligation (OR 1.23; 95% CI 0.69, 2.17; P = 0.48), and antenatal steroid use reduced the risk of PDA (OR 0.62; 95% CI 0.42, 0.90; P = 0.01) after chorioamnionitis. Conclusions The results from this meta-analysis support an association between maternal chorioamnionitis and PDA in offspring.
Collapse
|
32
|
Pugni L, Pietrasanta C, Acaia B, Merlo D, Ronchi A, Ossola MW, Bosari S, Mosca F. Chorioamnionitis and neonatal outcome in preterm infants: a clinical overview. J Matern Fetal Neonatal Med 2015; 29:1525-9. [PMID: 26135227 DOI: 10.3109/14767058.2015.1053862] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Lorenza Pugni
- a Department of Clinical Sciences and Community Health , NICU
| | | | | | - Daniela Merlo
- c Department of Pathophysiology and Organ Transplantation, Division of Pathology , Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, University of Milan , Milan , Italy
| | - Andrea Ronchi
- a Department of Clinical Sciences and Community Health , NICU
| | | | - Silvano Bosari
- c Department of Pathophysiology and Organ Transplantation, Division of Pathology , Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, University of Milan , Milan , Italy
| | - Fabio Mosca
- a Department of Clinical Sciences and Community Health , NICU
| |
Collapse
|
33
|
|
34
|
Miyazaki K, Furuhashi M, Ishikawa K, Tamakoshi K, Hayashi K, Kai A, Ishikawa H, Murabayashi N, Ikeda T, Kono Y, Kusuda S, Fujimura M. Long-term outcomes of antenatal corticosteroids treatment in very preterm infants after chorioamnionitis. Arch Gynecol Obstet 2015; 292:1239-46. [PMID: 25990481 DOI: 10.1007/s00404-015-3762-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2014] [Accepted: 05/13/2015] [Indexed: 11/25/2022]
Abstract
PURPOSE To evaluate the effect of antenatal corticosteroids (AC) therapy on short- and long-term outcomes among very low birth weight preterm infants after histologic chorioamnionitis (HCA). METHODS We performed a retrospective analysis of 5240 single very low birth weight (VLBW) infants born at 22 + 0 and 33 + 6 weeks of gestation between 2003 and 2007, who registered to the Neonatal Research Network Japan. The effects of AC therapy on mortality, neurodevelopmental outcomes at 3 years of age and neonatal morbidities were analyzed in the groups with or without HCA using logistic regression analysis. RESULTS In the study subjects, 840 were with HCA, 2734 were without HCA, and 1666 were excluded without data for HCA. AC therapy was significantly associated with decreasing mortality before 3 years of age; [0.52 (0.32-0.86)], [odds ratio (95 % confidence intervals]. There were no differences between the two groups regarding neurodevelopmental outcomes, including cerebral palsy [0.90 (0.41-1.99)], development quotient <70 [0.93 (0.48-1.81)], visual impairment [0.46 (0.04-5.18)], and severe hearing impairment [4.00 (0.30-53.4)] in the group with HCA as well as without HCA. Regarding neonatal morbidities, AC therapy was associated with a lower incidence of respiratory distress syndrome [0.67 (0.50-0.91)], sepsis [0.62 (0.41-0.94)], late-onset adrenal insufficiency [0.62 (0.39-0.98)] and an increased incidence of chronic lung disease [1.62 (1.18-2.24)] in the group with HCA. In the group without HCA, AC therapy was associated with decreasing respiratory distress syndrome [0.60 (0.43-0.84)] and increasing chronic lung disease [1.34 (1.11-1.62)]. CONCLUSION AC therapy is significantly associated with reduced mortality before 3 years of age in VLBW infants with HCA, but not with neurodevelopmental outcomes, which was same as the results found in infants without HCA. AC therapy is recommended for women with suspected chorioamnionitis, as well as those without chorioamnionitis.
Collapse
Affiliation(s)
- Ken Miyazaki
- Department of Obstetrics and Gynecology, Japanese Red Cross Nagoya Daiichi Hospital, 3-15 Michishita-cho, Nakamura-ku, Nagoya, 453-8511, Japan.
| | - Madoka Furuhashi
- Department of Obstetrics and Gynecology, Japanese Red Cross Nagoya Daiichi Hospital, 3-15 Michishita-cho, Nakamura-ku, Nagoya, 453-8511, Japan
| | - Kaoru Ishikawa
- Department of Endowed Chair for Regeneration of Medicine in Kuwana District, Suzuka University of Medical Science, Mie, Japan
| | - Koji Tamakoshi
- Department of Nursing, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Kazutoshi Hayashi
- Department of Obstetrics and Gynecology, Kochi Health Sciences Center, Kochi, Japan
| | - Akihiro Kai
- Department of Neonatology, Aizenbashi Hospital, Osaka, Japan
| | - Hiroshi Ishikawa
- Department of Obstetrics, Kanagawa Children's Medical Center, Yokohama, Japan
| | - Nao Murabayashi
- Department of Obstetrics and Gynecology, Mie University Graduate School of Medicine, Mie, Japan
| | - Tomoaki Ikeda
- Department of Obstetrics and Gynecology, Mie University Graduate School of Medicine, Mie, Japan
| | - Yumi Kono
- Department of Pediatrics, Jichi Medical University, Tochigi, Japan
| | - Satoshi Kusuda
- Department of Neonatology, Maternal and perinatal Center, Tokyo Women's Medical University, Tokyo, Japan
| | - Masanori Fujimura
- Department of Neonatology, Osaka Medical Center and Research Institute for maternal and Child Health, Osaka, Japan
| |
Collapse
|
35
|
Kipfmueller F, Schneider J, Prusseit J, Dimitriou I, Zur B, Franz AR, Bartmann P, Mueller A. Role of Neutrophil CD64 Index as a Screening Marker for Late-Onset Sepsis in Very Low Birth Weight Infants. PLoS One 2015; 10:e0124634. [PMID: 25894336 PMCID: PMC4404048 DOI: 10.1371/journal.pone.0124634] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2014] [Accepted: 03/17/2015] [Indexed: 01/30/2023] Open
Abstract
Introduction The role of CD64 in late onset sepsis (LOS) in preterm infants has been described in several studies. Aim of this study was to investigate whether CD64 expression is increased in the days before clinical manifestation of LOS. Methods Patients with birth weight below 1,500g were eligible for study participation. During routine blood sampling CD64 index was determined between day of life 4 and 28. Patients were allocated to one of four groups: (1) blood-culture positive sepsis, (2) clinical sepsis, (3) symptoms of infection without biochemical evidence of infection, or (4) patients without suspected infection. Kinetics of CD64 expression were compared during a period before and after the day of infection in the respective groups. Results 50 infants were prospectively enrolled and allocated to each group as follows: group (1) n = 7; group (2) n = 10; group (3) n = 8; and group (4) n = 25. CD64 index was elevated in 57% of patients in group (1) at least two days before infection. In contrast only 20% in the clinical sepsis group and 0% in group (3) had an elevated CD64 index in the days before infection. 10 of the 25 patients in the control group (4) presented increased CD64 index values during the study period. Conclusions The CD64 index might be a promising marker to detect LOS before infants demonstrate signs or symptoms of infection. However, larger prospective studies are needed to define optimal cut-off values and to investigate the role of non-infectious inflammation in this patient group.
Collapse
Affiliation(s)
- Florian Kipfmueller
- Department of Neonatology and Pediatric Critical Care, University Children‘s Hospital Bonn, Bonn, Germany
- * E-mail:
| | - Jessica Schneider
- Department of Neonatology and Pediatric Critical Care, University Children‘s Hospital Bonn, Bonn, Germany
| | - Julia Prusseit
- Department of Neonatology and Pediatric Critical Care, University Children‘s Hospital Bonn, Bonn, Germany
| | - Ioanna Dimitriou
- Department of Medical Biometry, Informatics and Epidemiology, University Hospital Bonn, Bonn, Germany
| | - Berndt Zur
- Institute for Clinical Chemistry and Clinical Pharmacology, University Hospital Bonn, Bonn, Germany
| | - Axel R. Franz
- Department of Neonatology and Pediatric Critical Care, University Children‘s Hospital Bonn, Bonn, Germany
- Current affiliation: Department of Neonatology, University Children’s Hospital Tuebingen, Tuebingen, Germany
| | - Peter Bartmann
- Department of Neonatology and Pediatric Critical Care, University Children‘s Hospital Bonn, Bonn, Germany
| | - Andreas Mueller
- Department of Neonatology and Pediatric Critical Care, University Children‘s Hospital Bonn, Bonn, Germany
| |
Collapse
|
36
|
Abstract
Antenatal glucocorticoid has proven to be one of the most successful single therapeutic approaches for preventing serious consequences after preterm birth. The fetal compartment is protected against endogenous corticosteroid by the high endogenous 11β-hydroxysteroid dehydrogenase type 2 that converts cortisol to cortisone and by the poor responsiveness of the fetal hypothalamus to corticotropin-releasing hormone. High corticosteroid activity acutely enhances the functional maturity of the fetus. Persistently high fetal glucocorticoid activity has adverse effects on the growth and differentiation of the fetal brain and other organs. Intrauterine growth restriction may be associated with high fetal glucocorticoid activity. Antenatal glucocorticoid therapy which is aimed to be given within 1-10 days before preterm birth is likely to increase the success of postnatal noninvasive treatments of very preterm infants.
Collapse
Affiliation(s)
- Mikko Hallman
- PEDEGO Research Center and Medical Research Center Oulu, University of Oulu, and Department of Children and Adolescents, Oulu University Hospital, Oulu, Finland
| |
Collapse
|
37
|
Abstract
Chorioamnionitis is the process of active infection within the amniotic cavity that induces an inflammatory response. A wide variety of pathologic organisms can cause chorioamnionitis. Prompt diagnosis and timely treatment with broad-spectrum antibiotics can help avert the significant short-term and long-term consequences that may result. This review aims to summarize the up-to-date diagnosis criteria, treatment protocols, and long-term sequelae of missed diagnoses or poorly treated disease. It also calls for future studies that aim to better understand the mechanism of disease and to develop better detection and intervention methods to prevent the significant associated morbidity.
Collapse
|
38
|
Raju TNK, Mercer BM, Burchfield DJ, Joseph GF. Periviable birth: executive summary of a Joint Workshop by the Eunice Kennedy Shriver National Institute of Child Health and Human Development, Society for Maternal-Fetal Medicine, American Academy of Pediatrics, and American College of Obstetricians and Gynecologists. J Perinatol 2014; 34:333-42. [PMID: 24722647 DOI: 10.1038/jp.2014.70] [Citation(s) in RCA: 75] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2014] [Accepted: 02/21/2014] [Indexed: 11/09/2022]
Abstract
This is an executive summary of a workshop on the management and counseling issues of women anticipated to deliver at a periviable gestation (broadly defined as 20 0/7 through 25 6/7 weeks of gestation), and the treatment options for the newborn. Upon review of the available literature, the workshop panel noted that the rates of neonatal survival and neurodevelopmental disabilities among the survivors vary greatly across the periviable gestations and are significantly influenced by the obstetric and neonatal management practices (for example, antenatal steroid, tocolytic agents and antibiotic administration; cesarean birth; and local protocols for perinatal care, neonatal resuscitation and intensive care support). These are, in turn, influenced by the variations in local and regional definitions of limits of viability. Because of the complexities in making difficult management decisions, obstetric and neonatal teams should confer prior to meeting with the family, when feasible. Family counseling should be coordinated with the goal of creating mutual trust, respect and understanding, and should incorporate evidence-based counseling methods. Since clinical circumstances can change rapidly with increasing gestational age, counseling should include discussion of the benefits and risks of various maternal and neonatal interventions at the time of counseling. There should be a plan for follow-up counseling as clinical circumstances evolve. The panel proposed a research agenda and recommended developing educational curricula on the care and counseling of families facing the birth of a periviable infant.
Collapse
Affiliation(s)
- T N K Raju
- The Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, USA
| | - B M Mercer
- The Society for Maternal-Fetal Medicine and Case Western Reserve University-MetroHealth Medical Center, Cleveland, OH, USA
| | - D J Burchfield
- The American Academy of Pediatrics and University of Florida, Gainesville, FL, USA
| | - G F Joseph
- The American College of Obstetricians and Gynecologists, Washington, DC, USA
| |
Collapse
|
39
|
Periviable birth: executive summary of a joint workshop by the Eunice Kennedy Shriver National Institute of Child Health and Human Development, Society for Maternal-Fetal Medicine, American Academy of Pediatrics, and American College of Obstetricians and Gynecologists. Am J Obstet Gynecol 2014; 210:406-17. [PMID: 24725732 DOI: 10.1016/j.ajog.2014.02.027] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2014] [Accepted: 02/25/2014] [Indexed: 01/01/2023]
Abstract
This is an executive summary of a workshop on the management and counseling issues of women anticipated to deliver at a periviable gestation (broadly defined as 20 0/7 through 25 6/7 weeks of gestation) and the treatment options for the newborn infant. Upon review of the available literature, the workshop panel noted that the rates of neonatal survival and neurodevelopmental disabilities among the survivors vary greatly across the periviable gestations and are significantly influenced by the obstetric and neonatal management practices (eg, antenatal steroid, tocolytic agents, and antibiotic administration; cesarean birth; and local protocols for perinatal care, neonatal resuscitation, and intensive care support). These are, in turn, influenced by the variations in local and regional definitions of limits of viability. Because of the complexities in making difficult management decisions, obstetric and neonatal teams should confer prior to meeting with the family, when feasible. Family counseling should be coordinated with the goal of creating mutual trust, respect, and understanding and should incorporate evidence-based counseling methods. Since clinical circumstances can change rapidly with increasing gestational age, counseling should include discussion of the benefits and risks of various maternal and neonatal interventions at the time of counseling. There should be a plan for follow-up counseling as clinical circumstances evolve. The panel proposed a research agenda and recommended developing educational curricula on the care and counseling of families facing the birth of a periviable infant.
Collapse
|
40
|
|
41
|
Thomas W, Speer CP. Chorioamnionitis is essential in the evolution of bronchopulmonary dysplasia--the case in favour. Paediatr Respir Rev 2014; 15:49-52. [PMID: 24128984 DOI: 10.1016/j.prrv.2013.09.004] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Bronchopulmonary dysplasia (BPD) is a major sequel of extremely premature birth. Multiple ante- and postnatal factors act in concert to injure the immature lung in the pathogenesis of the disease. Among them, chorioamnionitis--according to current evidence--plays a pivotal role. Pulmonary inflammatory processes seen in animal models of chorioamnionitis resemble those seen in premature infants who developed BPD. Chorioamnionitis can doubtlessly induce extremely preterm birth, thus contributing to a gestation-dependent risk of BPD. A gestation-independent association of chorioamnionitis with an increased risk of developing BPD has been demonstrated by a recent systematic review of clinical observational studies. Antenatal inflammation with signs of a systemic fetal response reduces the response to exogenous surfactant in infants with respiratory distress syndrome, leading to a longer need for mechanical ventilation. Moreover, chorioamnionitis increases the risk of early onset sepsis. Both mechanical ventilation and sepsis are, however, major postnatal risk factors for BPD.
Collapse
Affiliation(s)
- Wolfgang Thomas
- Mutterhaus der Borromaeerinnen, Department of Pediatrics, Feldstr. 6, 54290 Trier, Germany.
| | - Christian P Speer
- University of Würzburg, University Children's Hospital, Josef-Schneider-Str. 2, 97080 Würzburg, Germany.
| |
Collapse
|
42
|
Altered canonical Wingless-Int signaling in the ovine fetal lung after exposure to intra-amniotic lipopolysaccharide and antenatal betamethasone. Pediatr Res 2014; 75:281-7. [PMID: 24232635 DOI: 10.1038/pr.2013.226] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2013] [Accepted: 07/16/2013] [Indexed: 01/18/2023]
Abstract
BACKGROUND Antenatal inflammation and maternal corticosteroids induce fetal lung maturation but interfere with late lung development. Canonical Wingless-Int (Wnt) signaling directs lung development and repair. We showed that intra-amniotic (IA) lipopolysaccharide (LPS) exposure disrupted developmental signaling pathways in the preterm lamb lungs. Therefore, we hypothesized that pulmonary Wnt signaling was altered by exposure to IA LPS and/or antenatal corticosteroids. METHODS Ovine fetuses were exposed to IA LPS, maternal intramuscular betamethasone, a control saline injection, or a combination thereof at 107 and/or 114 d gestational age (term = 150 d gestational age) before delivery at 121 d gestational age. RESULTS IA LPS exposure decreased the lung expression of lymphoid enhancer-binding factor 1 (LEF1), a major Wnt pathway effector. WNT1, WNT4, and downstream messenger β-catenin decreased after LPS exposure. WNT7b mRNA increased fourfold 14 d post-LPS exposure. Betamethasone treatment 7 d before LPS exposure prevented the reduction in LEF1 expression, whereas betamethasone administration after LPS normalized the LPS-induced increase in Wnt7b mRNA. CONCLUSION IA LPS exposure decreased canonical Wnt signaling in the developing lung. Antenatal corticosteroids before or after IA inflammation had different effects on pulmonary Wnt signaling. This study provides new insights into possible mechanisms by which prenatal inflammation affects lung development and how corticosteroid can be beneficial in this setting.
Collapse
|
43
|
Amniotic fluid infection, inflammation, and colonization in preterm labor with intact membranes. Am J Obstet Gynecol 2014; 210:125.e1-125.e15. [PMID: 24274987 DOI: 10.1016/j.ajog.2013.11.032] [Citation(s) in RCA: 262] [Impact Index Per Article: 26.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2013] [Revised: 10/20/2013] [Accepted: 11/20/2013] [Indexed: 11/22/2022]
Abstract
OBJECTIVE The purpose of this study was to compare intraamniotic inflammation vs microbial invasion of the amniotic cavity (MIAC) as predictors of adverse outcome in preterm labor with intact membranes. STUDY DESIGN Interleukin-6 (IL-6) was measured in prospectively collected amniotic fluid from 305 women with preterm labor. MIAC was defined by amniotic fluid culture and/or detection of microbial 16S ribosomal DNA. Cases were categorized into 5 groups: infection (MIAC; IL-6, ≥11.3 ng/mL); severe inflammation (no MIAC; IL-6, ≥11.3 ng/mL); mild inflammation (no MIAC; IL-6, 2.6-11.2 ng/mL); colonization (MIAC; IL-6, <2.6 ng/mL); negative (no MIAC; IL-6, <2.6 ng/mL). RESULTS The infection (n = 27) and severe inflammation (n = 36) groups had similar latency (median, <1 day and 2 days, respectively) and similar rates of composite perinatal morbidity and mortality (81% and 72%, respectively). The colonization (n = 4) and negative (n = 195) groups had similar outcomes (median latency, 23.5 and 25 days; composite morbidity and mortality rates, 21% and 25%, respectively). The mild inflammation (n = 47) groups had outcomes that were intermediate to the severe inflammation and negative groups (median latency, 7 days; composite morbidity and mortality rates, 53%). In logistic regression adjusting for gestational age at enrollment, IL-6 ≥11.3 and 2.6-11.2 ng/mL, but not MIAC, were associated significantly with composite morbidity and mortality rates (odds ratio [OR], 4.9; 95% confidence interval [CI], 2.2-11.2, OR, 3.1; 95% CI, 1.5-6.4, and OR, 1.8; 95% CI, 0.6-5.5, respectively). CONCLUSION We confirmed previous reports that intraamniotic inflammation is associated with adverse perinatal outcomes whether or not intraamniotic microbes are detected. Colonization without inflammation appears relatively benign. Intraamniotic inflammation is not simply present or absent but also has degrees of severity that correlate with adverse outcomes. We propose the designation amniotic inflammatory response syndrome to denote the adverse outcomes that are associated with intraamniotic inflammation.
Collapse
|
44
|
|
45
|
Kuypers E, Jellema RK, Ophelders DRMG, Dudink J, Nikiforou M, Wolfs TGAM, Nitsos I, Pillow JJ, Polglase GR, Kemp MW, Saito M, Newnham JP, Jobe AH, Kallapur SG, Kramer BW. Effects of intra-amniotic lipopolysaccharide and maternal betamethasone on brain inflammation in fetal sheep. PLoS One 2013; 8:e81644. [PMID: 24358119 PMCID: PMC3866104 DOI: 10.1371/journal.pone.0081644] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2013] [Accepted: 10/15/2013] [Indexed: 01/16/2023] Open
Abstract
Rationale Chorioamnionitis and antenatal glucocorticoids are common exposures for preterm infants and can affect the fetal brain, contributing to cognitive and motor deficits in preterm infants. The effects of antenatal glucocorticoids on the brain in the setting of chorioamnionitis are unknown. We hypothesized that antenatal glucocorticoids would modulate inflammation in the brain and prevent hippocampal and white matter injury after intra-amniotic lipopolysaccharide (LPS) exposure. Methods Time-mated ewes received saline (control), an intra-amniotic injection of 10 mg LPS at 106d GA or 113d GA, maternal intra-muscular betamethasone (0.5 mg/kg maternal weight) alone at 113d GA, betamethasone at 106d GA before LPS or betamethasone at 113d GA after LPS. Animals were delivered at 120d GA (term=150d). Brain structure volumes were measured on T2-weighted MRI images. The subcortical white matter (SCWM), periventricular white matter (PVWM) and hippocampus were analyzed for microglia, astrocytes, apoptosis, proliferation, myelin and pre-synaptic vesicles. Results LPS and/or betamethasone exposure at different time-points during gestation did not alter brain structure volumes on MRI. Betamethasone alone did not alter any of the measurements. Intra-amniotic LPS at 106d or 113d GA induced inflammation as indicated by increased microglial and astrocyte recruitment which was paralleled by increased apoptosis and hypomyelination in the SCWM and decreased synaptophysin density in the hippocampus. Betamethasone before the LPS exposure at 113d GA prevented microglial activation and the decrease in synaptophysin. Betamethasone after LPS exposure increased microglial infiltration and apoptosis. Conclusion Intra-uterine LPS exposure for 7d or 14d before delivery induced inflammation and injury in the fetal white matter and hippocampus. Antenatal glucocorticoids aggravated the inflammatory changes in the brain caused by pre-existing intra-amniotic inflammation. Antenatal glucocorticoids prior to LPS reduced the effects of intra-uterine inflammation on the brain. The timing of glucocorticoid administration in the setting of chorioamnionitis can alter outcomes for the fetal brain.
Collapse
Affiliation(s)
- Elke Kuypers
- Department of Pediatrics, School of Mental Health and Neuroscience, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Reint K. Jellema
- Department of Pediatrics, School of Mental Health and Neuroscience, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Daan R. M. G. Ophelders
- Department of Pediatrics, School of Mental Health and Neuroscience, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Jeroen Dudink
- Department of Pediatrics, Erasmus Medical Center-Sophia, Rotterdam, The Netherlands
| | - Maria Nikiforou
- Department of Pediatrics, School of Mental Health and Neuroscience, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Tim G. A. M. Wolfs
- Department of Pediatrics, School of Mental Health and Neuroscience, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Ilias Nitsos
- School of Women’s and Infants’ Health, The University of Western Australia, Perth, Australia
- The Ritchie Centre, Monash Institute of Medical Research, Melbourne, Australia
| | - J. Jane Pillow
- School of Anatomy, Physiology and Human Biology, The University of Western Australia, Perth, Australia
| | - Graeme R. Polglase
- School of Women’s and Infants’ Health, The University of Western Australia, Perth, Australia
- The Ritchie Centre, Monash Institute of Medical Research, Melbourne, Australia
| | - Matthew W. Kemp
- School of Women’s and Infants’ Health, The University of Western Australia, Perth, Australia
| | - Masatoshi Saito
- School of Women’s and Infants’ Health, The University of Western Australia, Perth, Australia
| | - John P. Newnham
- School of Women’s and Infants’ Health, The University of Western Australia, Perth, Australia
| | - Alan H. Jobe
- School of Women’s and Infants’ Health, The University of Western Australia, Perth, Australia
- Division of Pulmonary Biology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States of America
| | - Suhas G. Kallapur
- School of Women’s and Infants’ Health, The University of Western Australia, Perth, Australia
- Division of Pulmonary Biology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States of America
| | - Boris W. Kramer
- Department of Pediatrics, School of Mental Health and Neuroscience, Maastricht University Medical Center, Maastricht, The Netherlands
- * E-mail:
| |
Collapse
|
46
|
Miyazaki K, Furuhashi M, Ishikawa K, Tamakoshi K, Ikeda T, Kusuda S, Fujimura M. The effects of antenatal corticosteroids therapy on very preterm infants after chorioamnionitis. Arch Gynecol Obstet 2013; 289:1185-90. [PMID: 24305749 DOI: 10.1007/s00404-013-3106-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2013] [Accepted: 11/18/2013] [Indexed: 11/28/2022]
Abstract
PURPOSE To evaluate the effectiveness of antenatal corticosteroids (AC) therapy on outcomes of very low birthweight infants with histologic chorioamnionitis. METHODS We performed a retrospective analysis of 10,935 single infants born at a gestational age between 22 + 0 and 33 + 6 weeks and birth weight <1,500 g. Clinical data were obtained from the Neonatal Research Network that included the tertiary neonatal intensive care units throughout Japan between 2003 and 2008. RESULTS Data of 7,896 infants were available for the period 2003-2008 and were included in the analysis. According to logistic regression analysis, AC were significantly associated with reduced mortality [odds ratio (OR) = 0.50; p < 0.001], lower incidence of respiratory distress syndrome (OR = 0.72; p < 0.001), neonatal seizure (OR = 0.65; p = 0.003) and intraventricular hemorrhage (OR = 0.68; p = 0.001) in cases after histologic chorioamnionitis compared with the cases had no AC therapy (n = 3,271 vs. 4,625). Antenatal corticosteroids were significantly associated with reduced mortality [odds ratio (OR) = 0.60; p < 0.001] among the cases without histologic chorioamnionitis. CONCLUSION In the retrospective population-based study in Japan, AC exposure was significantly associated with a lower rate of death and neurological morbidity in cases with histologic chorioamnionitis. These outcome data in Japan will be important for further improvement of antenatal practice and care.
Collapse
Affiliation(s)
- Ken Miyazaki
- Department of Obstetrics and Gynecology, Japanese Red Cross Nagoya Daiichi Hospital, 3-15 Michishita-cho, Nakamura-ku, Nagoya, 453-8511, Japan,
| | | | | | | | | | | | | |
Collapse
|
47
|
Erdemir G, Kultursay N, Calkavur S, Zekioğlu O, Koroglu OA, Cakmak B, Yalaz M, Akisu M, Sagol S. Histological chorioamnionitis: effects on premature delivery and neonatal prognosis. Pediatr Neonatol 2013; 54:267-74. [PMID: 23639744 DOI: 10.1016/j.pedneo.2013.03.012] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2012] [Revised: 11/02/2012] [Accepted: 03/08/2013] [Indexed: 10/26/2022] Open
Abstract
BACKGROUND Chorioamnionitis is closely related to premature birth and has negative effects on neonatal morbidity and mortality. METHODS In this prospective study, 43 mothers who delivered earlier than 35 gestational weeks and their 57 infants were evaluated clinically and with laboratory findings. Placentas and umbilical cords were investigated histopathologically for chorioamnionitis and funisitis. RESULTS The overall frequency of clinical and histological chorioamnionitis (HCA) was 8.3% and 23.2%, respectively. The frequency of HCA was 47.3% and 83.3% in mothers delivered <32 weeks and <30 weeks, respectively. Maternal demographic and clinical findings and also leukocyte and C-reactive protein values were not indicative of HCA. Infants of mothers with HCA had significantly lower Apgar scores together with higher SNAP-PE-II and CRIB scores. These infants had increased mechanical ventilator and surfactant requirements, higher incidences of patent ductus arteriosus, early sepsis, and bronchopulmonary dysplasia, and higher mortality rates. The effect of HCA on neonatal morbidity and mortality was more prominent than the effect of low birthweight and lower gestational age. CONCLUSION Chorioamnionitis not only causes premature deliveries, but is also associated with neonatal complications and increased mortality. Clinical findings and infectious markers in mother or infant do not predict the diagnosis of histological chorioamnionitis. Therefore, placental histopathology may have a role in predicting neonatal outcome in premature deliveries, especially those below 30 weeks.
Collapse
Affiliation(s)
- Gulin Erdemir
- Division of Neonatology, Department of Pediatrics, Ege University, Faculty of Medicine, Izmir, Turkey
| | | | | | | | | | | | | | | | | |
Collapse
|
48
|
Bhutta ZA, Giuliani F, Haroon A, Knight HE, Albernaz E, Batra M, Bhat B, Bertino E, McCormick K, Ochieng R, Rajan V, Ruyan P, Cheikh Ismail L, Paul V. Standardisation of neonatal clinical practice. BJOG 2013; 120 Suppl 2:56-63, v. [DOI: 10.1111/1471-0528.12312] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/15/2012] [Indexed: 11/27/2022]
Affiliation(s)
- ZA Bhutta
- Division of Women & Child Health; The Aga Khan University; Karachi; Pakistan
| | - F Giuliani
- SCDU Neonatologia; Dipartimento di Scienze Pediatriche e dell'Adolescenza; Università degli Studi di Torino; Torino; Italy
| | - A Haroon
- Division of Women & Child Health; The Aga Khan University; Karachi; Pakistan
| | - HE Knight
- Nuffield Department of Obstetrics & Gynaecology; Oxford Maternal & Perinatal Health Institute; Green Templeton College; University of Oxford; Oxford; UK
| | | | - M Batra
- University of Washington School of Medicine; Seattle; WA; USA
| | - B Bhat
- Department of Family & Community Health; Ministry of Health; Muscat; Sultanate of Oman
| | - E Bertino
- SCDU Neonatologia; Dipartimento di Scienze Pediatriche e dell'Adolescenza; Università degli Studi di Torino; Torino; Italy
| | - K McCormick
- Department of Paediatrics; John Radcliffe Hospital; Oxford; UK
| | - R Ochieng
- Faculty of Health Sciences; Aga Khan University; Nairobi; Kenya
| | - V Rajan
- Ketkar Nursing Home; Nagpur; India
| | - P Ruyan
- Maternal & Child Health Centre; Beijing Obstetrics & Gynaecology Hospital; Capital Medical University; Beijing; China
| | - L Cheikh Ismail
- Nuffield Department of Obstetrics & Gynaecology; Oxford Maternal & Perinatal Health Institute; Green Templeton College; University of Oxford; Oxford; UK
| | - V Paul
- Department of Paediatrics and WHO Collaborating Centre for Training & Research in Newborn Care; All India Institute of Medical Sciences; New Delhi; India
| | | |
Collapse
|
49
|
Yoo HS, Chang YS, Kim JK, Ahn SY, Kim ES, Sung DK, Jeon GW, Hwang JH, Shim JW, Park WS. Antenatal betamethasone attenuates intrauterine infection-aggravated hyperoxia-induced lung injury in neonatal rats. Pediatr Res 2013; 73:726-33. [PMID: 23493167 DOI: 10.1038/pr.2013.51] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Intrauterine infection can exacerbate postnatal hyperoxic lung injury. We hypothesized that antenatal betamethasone treatment attenuates hyperoxic lung injury aggravated by intrauterine infection in neonatal rats. METHODS Newborn Sprague-Dawley rats were divided into eight experimental groups according to (i) whether rats were exposed to normoxia (N) or hyperoxia (H, 85% oxygen) from postnatal day (P)1 to P14, (ii) whether antenatal betamethasone (0.2 mg/dose) or vehicle was administered to pregnant rats at gestation days (E)19 and E20, and (iii) whether intrauterine infection was induced or not antenatally. Intrauterine infection was induced by intracervical inoculation of Escherichia coli into pregnant rats on E19. We measured cytokine levels of tumor necrosis factor-α (TNF-α), interleukin (IL)-6, and IL-1β in P1 rat lungs and performed morphometric analyses and assessed inflammatory responses in lung tissue and bronchoalveolar lavage (BAL) at P14 by terminal deoxynucleotidyl transferase-mediated deoxyuridine triphosphate nick end labeling (TUNEL) staining and measurement of myeloperoxidase activity, collagen, and cytokine levels. RESULTS Cytokine levels in P1 rat lungs were increased by intrauterine infection, and these increases were attenuated by antenatal betamethasone. Hyperoxic lung injuries, indicated by morphometric changes and an inflammatory response in the lung and BAL fluid, were aggravated by intrauterine infection at P14. This aggravation was significantly attenuated by antenatal betamethasone. CONCLUSION Antenatal betamethasone attenuated aggravated hyperoxic lung injuries induced by intrauterine infection in neonatal rats via its anti-inflammatory actions.
Collapse
Affiliation(s)
- Hye Soo Yoo
- Department of Pediatrics, Samsung Medical Center, School of Medicine Sungkyunkwan University, Seoul, South Korea
| | | | | | | | | | | | | | | | | | | |
Collapse
|
50
|
Wolfe KB, Snyder CC, Gisslen T, Kemp MW, Newnham JP, Kramer BW, Jobe AH, Kallapur S. Modulation of lipopolysaccharide-induced chorioamnionitis in fetal sheep by maternal betamethasone. Reprod Sci 2013; 20:1447-54. [PMID: 23653388 DOI: 10.1177/1933719113488445] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
OBJECTIVE We tested the hypothesis that the order of exposure to maternal betamethasone and intra-amniotic (IA) lipopolysaccharide (LPS) will differentially modulate inflammation in the chorioamnion. STUDY DESIGN Time-mated Merino ewes with singleton fetuses received saline alone, IA LPS alone, maternal betamethasone before LPS, or betamethasone after LPS. We assessed inflammatory markers in the chorioamnion and the amniotic fluid. RESULTS Inflammatory cell infiltration, expression of myeloperoxidase, serum amyloid A3 (acute phase reactant) in the chorioamnion, and levels of interleukin (IL)-8 in the amniotic fluid increased 7 days after LPS exposure. Betamethasone prior to LPS decreased infiltration of the inflammatory cells, CD3+ T cells, and decreased the levels of IL-1β and IL-8 in the amniotic fluid. CONCLUSIONS Betamethasone 7 days prior to LPS exposure suppressed LPS-induced inflammation. The markers of inflammation largely had returned to the baseline 14 days after LPS exposure.
Collapse
Affiliation(s)
- Katherine B Wolfe
- 1Division of Maternal-Fetal Medicine, University of Cincinnati college of Medicine, Cincinnati, OH, USA
| | | | | | | | | | | | | | | |
Collapse
|