Abstract

BackgroundHistological chorioamnionitis (HC) is an intrauterine inflammatory process highly associated with preterm birth and adverse neonatal outcome. HC is often clinically silent and diagnosed postnatally by placental histology. Earlier identification could facilitate treatment individualisation to improve outcome in preterm newborns.AimDevelop a clinical prediction rule at birth for HC and HC with fetal involvement (HCF) in preterm newborns.MethodsClinical data and placental pathology were obtained from singleton preterm newborns (gestational age ≤32.0 weeks) born at Erasmus UMC Rotterdam from 2001 to 2003 (derivation cohort; n = 216) or Máxima MC Veldhoven from 2009 to 2010 (validation cohort; n = 206). HC and HCF prediction rules were developed with preference for high sensitivity using clinical variables available at birth.ResultsHC and HCF were present in 39% and 24% in the derivation cohort and in 44% and 22% in the validation cohort, respectively. HC was predicted with 87% accuracy, yielding an area under ROC curve of 0.95 (95%CI = 0.92–0.98), a positive predictive value of 80% (95%CI = 74–84%), and a negative predictive value of 93% (95%CI = 88–96%). Corresponding figures for HCF were: accuracy 83%, area under ROC curve 0.92 (95%CI = 0.88–0.96), positive predictive value 59% (95%CI = 52–62%), and negative predictive value 97% (95%CI = 93–99%). External validation expectedly resulted in some loss of test performance, preferentially affecting positive predictive rather than negative predictive values.ConclusionUsing a clinical prediction rule composed of clinical variables available at birth, HC and HCF could be predicted with good test characteristics in preterm newborns. Further studies should evaluate the clinical value of these rules to guide early treatment individualisation.

Highlights

  • Chorioamnionitis is an antenatal inflammatory state of the intrauterine environment strongly associated with prematurity [1]

  • histological chorioamnionitis (HC) was predicted with 87% accuracy, yielding an area under ROC curve of 0.95 (95%CI = 0.92–0.98), a positive predictive value of 80% (95%CI = 74–84%), and a negative predictive value of 93% (95%CI = 88–96%)

  • Corresponding figures for histological chorioamnionitis with fetal involvement (HCF) were: accuracy 83%, area under ROC curve 0.92 (95%CI = 0.88–0.96), positive predictive value 59% (95%CI = 52– 62%), and negative predictive value 97% (95%CI = 93–99%)

Read more

Summary

Introduction

Chorioamnionitis is an antenatal inflammatory state of the intrauterine environment strongly associated with prematurity [1]. Its presence in placentas from preterm infants has been associated with decreased respiratory distress syndrome, but increased incidences of bronchopulmonary dysplasia (BPD), necrotising enterocolitis (NEC) and neurologic sequelae, including white matter damage and cerebral palsy [2,4,5,6]. These effects have generally been shown to be more pronounced when additional signs of fetal inflammation including funisitis are present [2,4,5]. Earlier identification could facilitate treatment individualisation to improve outcome in preterm newborns

Objectives
Methods
Results
Discussion
Conclusion
Full Text
Published version (Free)

Talk to us

Join us for a 30 min session where you can share your feedback and ask us any queries you have

Schedule a call