Antepartum acute maternal infection: Is the preterm neonate protected?

Abstract

One of two preterm neonates born < 29 weeks gestational age exhibits some degree of cerebral white matter injury, the etiology of which remains unclear. We hypothesized that systemic maternal inflammation from infection leads to fetal neuroinflammation, which has a strong role in the pathogenesis of poor short-term and long-term neonatal outcomes. The aim of this study was to examine the relationship between antepartum maternal infection and short-term neonatal outcomes. We conducted a retrospective cohort study of preterm neonates < 29 weeks of gestational age born at our institution from 01/2010-12/2020. We excluded those with neonates receiving comfort care in the delivery room or with congenital or chromosomal abnormalities. Maternal data was extracted including co-morbidities, obstetric outcomes and complications, and maternal infections and treatments. Maternal antepartum infection status was categorized as (1) no infection, (2) non-severe acute infection and (3) severe acute infection. Infant data extracted included short-term outcomes of bronchopulmonary dysplasia, necrotizing enterocolitis, sepsis, intraventricular hemorrhage, pneumothorax, pneumonia, pulmonary hypertension, days ventilated, days on CPAP, and maximum FiO2. Analyses included c2, Fisher’s exact test, one-way analysis of variance, and Kruskal-Wallis test with p < .05 considered significant. 1121 neonates were born < 29 weeks to 983 women; 788 (70.3%) had no infection documented prenatally, 240 (21.4%) an acute non-severe infection, and 93 (8.3%) an acute severe infection. Rates of prolonged rupture of membranes were higher in the severe acute infection group whereas rates of preeclampsia and cesarean section were lower (Table 1). The presence of any acute infection did not correlate with short-term neonatal outcomes (Table 2). Acute maternal infection does not correlate with short-term neonatal outcomes. The neonate may be protected from maternal inflammation through placental-mediate mechanisms.View Large Image Figure ViewerDownload Hi-res image Download (PPT)