Abstract
ObjectiveTo investigate the impact of different stages of intrauterine inflammation (IUI) on neonatal outcomes, before and after adjusting for gestational age (GA) and other perinatal confounders.MethodsThis was an observational, prospective, single-center cohort study including all eligible neonates with GA < 35 weeks and/or birth weight ≤ 1500 g born at a 3rd level Neonatal Intensive Care Unit between 2011 and 2014. Pathological patterns of placenta, membranes and cord were classified according to Redline’s criteria. Multivariable linear and logistic regression models were applied, either including or not GA among the covariates.ResultsOf the 807 enrolled neonates, 134 (16.6%) had signs of IUI: among these, 54.5% showed just histological chorioamnionitis (HCA), 25.4% had HCA + funisitis (FUN) stage 1, and 20.1% had HCA + FUN stage 2–3. At univariate analysis, HCA increased the risk for retinopathy of prematurity (ROP) and bronchopulmonary dysplasia, while FUN (any stage) had a deleterious impact on all outcomes investigated. After adjustment for covariates not including GA, HCA was a risk factor only for ROP (OR = 2.8, CI: 1–7.8), while FUN (any stage) was still associated with increased ORs for all outcomes (p <0.01). Upon inclusion of GA in the regression model, the results differed remarkably. HCA was associated with lower risk for mechanical ventilation (OR = 0.3, CI: 0.1–0.7) and need for surfactant (OR = 0.5, CI: 0.2–0.9), while FUN (any stage) worsened clinical conditions at birth (p <0.05), increased the risk for early-onset sepsis (p <0.01), and increased the length of mechanical ventilation (FUN stage 2–3 only, RC = 6.5 days, CI: 2–11). No other outcome was affected.ConclusionsIUI, especially FUN, negatively impact most neonatal morbidities, but its effect is partially reverted adjusting for GA. Considered that GA is an intermediate variable interposed between prenatal causes of prematurity and outcomes, the appropriateness of adjusting for GA may be questionable.
Highlights
HCA increased the risk for retinopathy of prematurity (ROP) and bronchopulmonary dysplasia, while FUN had a deleterious impact on all outcomes investigated
intrauterine inflammation (IUI), especially FUN, negatively impact most neonatal morbidities, but its effect is partially reverted adjusting for gestational age (GA)
Considered that GA is an intermediate variable interposed between prenatal causes of prematurity and outcomes, the appropriateness of adjusting for GA may be questionable
Summary
Acute perinatal intrauterine inflammation (IUI) is one of the leading causes of preterm birth worldwide and its prevalence increases with decreasing gestational age (GA): up to 70% of preterm births at 23–25 weeks of GA are associated with IUI [1,2,3]. IUI may involve both maternal and fetal compartment, with signs of inflammation limited to the membranes chorion and amnion (maternal inflammation, referred to as histological chorioamnionitis, HCA) or within the walls of umbilical cord vessels (fetal inflammation or funisitis, FUN) [4]. These histopathological patterns still represent the gold standard for the diagnosis of IUI and few different classification systems have been proposed over the past 30 years [5,6,7,8]. Most studies considered GA at birth among other confounding factors, few authors clearly explored the role of GA independently of other covariates
Sign-in/Register to view highlights & summary 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 callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
