395 Brain Damage of Extremely Low Birth Weight Infants with Histopathologic Chorioamnionitis

Abstract

Background/aims: Neonatal cerebral white matter injury is the major precursor for neurological impairment and cerebral palsy. Chorioamnionitis has been associated with periventricular leukomalacia (PVL) in very low birth weight (VLBW) infants. We evaluated the association between occurrence and pathological severity of histological chorioamnionitis (HCA) and brain damage in VLBW infants. Methods: A prospective histological study on 287 placentas was performed in preterm infants (< 32+6 weeks gestation), consecutively admitted to III level NICU of Padua University from January 1999 to December 2004. Development of intraventricular hemorrhage (IVH) or PVL was related to the evidence of HCA and to chorioamnion inflammatory scores, according to Naeye et al. Results: Among the 287 NICU admitted preterm infants, 68 (23.6%) showed HCA, and 39/287 (13.5%) had brain damage, IVH or PVL. Brain damage was present in 15/68 (22%) of infants in the setting of HCA and in 24/219 (10.9%) of infants in the absence of HCA (p<0.05). HCA is also associated with a significantly increased frequency of PVL (5.8% vs 0.4%; p< 0.01), but failed to reveal any association with IVH (16.1% vs 10.5%; p=0.2). However, severe fetal HCA, stage II-III vs I and grade II-III vs I, were unrelated to brain damage. HCA infants were comparable to non-HCA infants in all selected demographics and clinical variables, except for increased vaginal delivery and lower gestational age (27±2.5 vs 30±2.3; p<0.05) Conclusions: HCA in preterm infants <32 weeks gestation is significantly associated with PVL occurrence, unrelated to fetal sites and severity of chorioamnion inflammation, but fails to induce any effect on IVH occurrence.