Abstract
BackgroundThere are conflicting results in the literature on the impact of chorioamnionitis on neonatal respiratory morbidities. However, most studies are based on small clinical samples and fail to account for the competing risk of perinatal death. This study aimed to determine whether chorioamnionitis affects the incidence of respiratory distress syndrome (RDS) and bronchopulmonary dysplasia (BPD) after accounting for the increased risk of death.MethodsRetrospective cohort study using linked birth and infant death registration and hospitalization records from Washington State between 2002 and 2011 (n = 763,671 singleton infants and n = 56,537 singleton preterm infants). Logistic regression models based on the traditional and fetuses-at-risk approaches were used to model two composite outcomes namely RDS and perinatal death and BPD and perinatal death. Confounders adjusted for in the models included maternal age, race, diabetes, hypertension, antenatal corticosteroids, mode of delivery and infant sex.ResultsWhile models using the traditional approach found a significant association only between chorioamnionitis and composite BPD and perinatal death (OR = 1.23, 95% CI: 1.01–1.50); using the fetuses-at-risk approach, there was a significant association between chorioamnionitis and both composite outcomes (RDS and perinatal death OR = 2.74, 2.50–3.01; BPD and perinatal death OR = 5.18, 95% CI: 4.39–6.11).ConclusionThe fetuses-at-risk approach models the causal impact of chorioamnionitis on the development of the fetal lung and shows an increased risk of RDS, BPD and perinatal death associated with such maternal infection.
Highlights
There are conflicting results in the literature on the impact of chorioamnionitis on neonatal respiratory morbidities
Under the fetuses-at-risk approach, the incidence rate of chorioamnionitis was stable until 30 weeks of gestation, at which point it increased in a linear fashion; whereas, under the traditional approach, the incidence rate of chorioamnionitis peaked at 23–24 weeks and declined steadily until 36 weeks of gestation (Fig. 1)
Under the traditional model, the incidence of composite bronchopulmonary dysplasia (BPD) and perinatal mortality peaked at early preterm gestations (Fig. 2c), while under the fetuses-at-risk approach, this pattern was only observed for pregnancies affected by chorioamnionitis (Fig. 2d)
Summary
There are conflicting results in the literature on the impact of chorioamnionitis on neonatal respiratory morbidities. This study aimed to determine whether chorioamnionitis affects the incidence of respiratory distress syndrome (RDS) and bronchopulmonary dysplasia (BPD) after accounting for the increased risk of death. Understanding of the role of chorioamnionitis in neonatal respiratory morbidities is complicated because stillborn fetuses and live born infants who die during the neonatal period are typically excluded from studies examining the impact of chorioamnionitis on respiratory outcomes. This is problematic as chorioamnionitis has been shown to increase the risk of neonatal death [10]. This study aimed to determine whether chorioamnionitis affects the incidence of neonatal respiratory outcomes such as respiratory distress syndrome and bronchopulmonary dysplasia (after accounting for effects on perinatal death)
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