Abstract
BackgroundChorioamnionitis is associated with various neonatal short- and long-term morbidities. The effect of chorioamnionitis on premature children’s outcomes remains controversial. The aim of this study is to investigate the relationship between histological chorioamnionitis (HCA) and physiological development, wheezing, and atopic diseases in preterm children.MethodsSingleton, preterm children (< 34 weeks), whose mother underwent pathological placental examinations, were retrospectively enrolled and the outcomes were assessed at 24–40 months during follow-up. Wheezing and atopic diseases including eczema, food allergies, and allergic rhinitis were screened by a questionnaire along with medical diagnosis. Anthropometric indexes and blood pressure were measured. Cognitive and behavioural developments were assessed by the Gesell Development and Diagnosis Scale. Blood IgE and routine examination were analyzed with venous blood and serum metabolomic profiling was assessed via liquid chromatography-mass spectrometry (LC-MS). A multivariate logistic regression model was used to estimate the association between HCA and the current outcomes.ResultsAmong the 115 enrolled children, 47 were exposed to HCA. The incidence of wheezing was significantly higher in children exposed to HCA, as 38.30% of children who were exposed to HCA and 16.18% of children who were not had been diagnosed with wheezing. After adjusting for related confounders in the multivariate logistic regression model, there remained a 2.72-fold increased risk of wheezing in children with HCA (adjusted odds ratio, aOR, 2.72; 95% confidence interval, 1.02–7.23). Moreover, 163 differential metabolites, such as butanoic acid, annotemoyin 1 and charine, were identified in the HCA exposed children’s serum. Enrichment analysis revealed that these compounds participated in diverse key metabolomic pathways relating to physical and neuro- developments, including glycerophospholipid, alpha-linolenic acid and choline metabolisms. There were no significant differences in atopic diseases, serum IgE, eosinophils’ level, anthropometric indexes, blood pressure, or cognitive or behavioural developments between the two groups.ConclusionHCA exposure is associated with an increased risk of wheezing in preterm children less than 34 gestational weeks.
Highlights
Chorioamnionitis is associated with various neonatal short- and long-term morbidities
Variables that were significantly associated with histological chorioamnionitis (HCA) included a smaller gestation age, preterm premature rupture of the membranes (PPROM), vaginal delivery and the use of antibiotics in the first year of life (Table 1)
We found no significant difference in height, weight, skinfold thickness or blood pressure between the preterm children exposed to HCA or not at the age of 2–3.5 years
Summary
Chorioamnionitis is associated with various neonatal short- and long-term morbidities. The aim of this study is to investigate the relationship between histological chorioamnionitis (HCA) and physiological development, wheezing, and atopic diseases in preterm children. Studies have revealed that preterm birth is associated with an increased risk of chronic diseases in adulthood and impairs neurodevelopment such as cognitive and motor impairments and hearing loss [2]. Many studies have associated chorioamnionitis with various short- and long-term adverse outcomes, such as intrauterine growth restriction, cerebral palsy, chronic lung disease, wheezing or asthma later in life [3, 4]. Several studies found that chorioamnionitis increased the risk of long-term cognitive and behavioural impairments in preterm children [5, 6], while others did not [7]
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