Chorioamnionitis and neurodevelopment

Abstract

The association between clinical and/or histological chorioamnionitis and poor neurodevelopmental outcomes or death in newborns has been debated, with multiple positive and negative studies in the literature. This association for preterm birth perhaps is even more controversial. As more is learned about the types of infections that are associated with premature delivery, any interpretation of an outcome relative to a simple diagnosis of chorioamnionitis is inadequate. Some pregnancies are complicated by chronic and indolent infections with single or multiple organisms not normally considered to be pathogenic, and others result in preterm deliveries with clear pathogens. Inflammation-associated preterm labor may be primarily from the endometrium and minimally involve the fetus, or the fetus may mount a systemic inflammatory response.In this issue of The Journal, Salas et al carefully characterized and graded cord inflammation to better identify the severity of the inflammation for a large number of preterm deliveries. They report that a severe fetal inflammatory response was associated with death or a poor neurodevelopmental outcome in preterm infants. The logical association between fetal exposure to inflammation and brain injury becomes apparent with a better assessment of the inflammation. No doubt adverse outcomes will associate with specific organisms, the duration of the fetal exposure, and characteristics of the fetal and maternal inflammatory responses. Much more needs to be learned about how to assess fetal risks to better direct the timing of delivery.Article page 652▶ The association between clinical and/or histological chorioamnionitis and poor neurodevelopmental outcomes or death in newborns has been debated, with multiple positive and negative studies in the literature. This association for preterm birth perhaps is even more controversial. As more is learned about the types of infections that are associated with premature delivery, any interpretation of an outcome relative to a simple diagnosis of chorioamnionitis is inadequate. Some pregnancies are complicated by chronic and indolent infections with single or multiple organisms not normally considered to be pathogenic, and others result in preterm deliveries with clear pathogens. Inflammation-associated preterm labor may be primarily from the endometrium and minimally involve the fetus, or the fetus may mount a systemic inflammatory response. In this issue of The Journal, Salas et al carefully characterized and graded cord inflammation to better identify the severity of the inflammation for a large number of preterm deliveries. They report that a severe fetal inflammatory response was associated with death or a poor neurodevelopmental outcome in preterm infants. The logical association between fetal exposure to inflammation and brain injury becomes apparent with a better assessment of the inflammation. No doubt adverse outcomes will associate with specific organisms, the duration of the fetal exposure, and characteristics of the fetal and maternal inflammatory responses. Much more needs to be learned about how to assess fetal risks to better direct the timing of delivery. Article page 652▶ Histological Characteristics of the Fetal Inflammatory Response Associated with Neurodevelopmental Impairment and Death in Extremely Preterm InfantsThe Journal of PediatricsVol. 163Issue 3PreviewTo test the hypothesis that increasing severity of the fetal inflammatory response (FIR) would have a dose-dependent relationship with severe neurodevelopmental impairment or death in extremely preterm infants. Full-Text PDF