Presence Of Intrauterine Infection Research Articles

Influence of early fluid overload on bronchopulmonary dysplasia in very low-birth-weight infants.

ObjectiveThis study aimed to determine the influence of fluid overload on bronchopulmonary dysplasia (BPD) in very low-birth-weight infants (VLBWI) within 1 week after birth.MethodsThis was a retrospective case control study conducted in the Jingzhou Central Hospital. The clinical data of VLBWI (with a birth weight [BW] < 1,500 g and 26 weeks ≤ gestational age [GA] < 32 weeks) who were admitted to the neonatal intensive care unit of this hospital from January 2016 to December 2021 were analyzed retrospectively. A total of 157 cases were enrolled and divided into a BPD group (n = 60) and a non-BPD group (n = 97) according to whether BPD was present. The general condition, fluid intake, and fluid overload of the two groups of neonates within 1 week after birth were compared. The logistic regression was used to assess the association between infant characteristics and BPD. The ROC curve was used to assess how well the 7 day cumulative fluid overload predicted BPD, and to identify an optimal cut off for prediction.ResultsThe comparison of the patients' general condition revealed that the neonates in the BPD group had a younger GA, lower BW, lower 5-min Apgar score, longer duration of invasive mechanical ventilation, and higher incidence of intrauterine infections and administration of surfactants (P < 0.05). The differences in the other indicators were not statistically significant between the two groups. The logistic regression analysis revealed that a younger GA, the presence of intrauterine infection, and a 7-day cumulative fluid overload were the risk factors for the development of BPD. A ROC curve was plotted with the 7-day cumulative fluid overload as the test variable and BPD as the status variable. The area under the curve was 0.75 (95% confidence interval: 0.664–0.826, P = 0.042), with a sensitivity of 76.7% and a specificity of 70.1%, corresponding to a 7-day cumulative fluid overload of 36.2%.ConclusionA younger GA, the presence of intrauterine infection, and a 7-day cumulative fluid overload were risk factors for the development of BPD. A 7 day cumulative fluid overload threshold of 36.2% best predicted the development of BPD.

Prediction injury of the central nervous system in the neonatal period in preterm newborns

Objective: to develop a system for predicting the probability of developing damage of the central nervoussystem (CNS) in the neonatal period in children who was born prematurely. Materials and methods: the main group of the study is premature newborns with gestational age (GA) less than 36 weeks inclusive (n = 60), the control group – fullterm newborns (n = 35). In the process of dynamic observation, the main group was divided into subgroups depending on the diagnosed CNS injury in the neonatal period, according to the neurosonography (intraventricular hemorrhages (IVH), periventricular leukomalacia (PVL): subgroup 1 (prematurity babies with CNS injury) – 25 people, subgroup 2 (premature babies without CNS injury) – 35 people. we estimated clinical and anamnestic, laboratory and instrumental data of children at birth and in dynamics, indicators of antioxidant protection (manganese-containing superoxide dismutase (Mn-SOD), copper, zinc-containing superoxide dismutase (Cu, Zn-SOD), reduced glutathione (GSH), oxidized glutathione (GSSG), total antioxidant capacity of blood (TAS/TAC), oxidative stress (TOS/TOC), 4 polymorphisms of Mn-SOD gene. Results: we designed two prognostic models which can determine the probability of developing IVH and PVL in the neonatal period in premature newborns. This models are included GA, Apgar scores at 1 and 5 minutes of life, presence of respiratory failure at birth, invasive mechanical ventilation in the neonatal period, presence of intrauterine infection in the neonatal period and indicators of antioxidant protection (GSH, TAS/TAC; model 2). Conclusions: a comprehensive assessment of the clinical and anamnestic data of premature newborns at birth, as well as the determination of indicators that take into account the level of antioxidant protection, will make it possible to identify a premature baby at the risk for organic injury of the CNS and to correct the therapeutic strategies in the neonatal period.

Identification, diagnosis, and early intervention of children with developmental language disorder in Ningxia.

BackgroundIt is reported that the incidence of language development disorder in children at the age of 2 is as high as 17.0%. Timely discovery of the high-risk factors of language development disorder in children and early intervention can greatly reduce the incidence of language development disorder and shorten the course and condition of the patients with language development disorder. Therefore, in order to facilitate prompt diagnosis and early interventions for children with language development disorder (DLD) and improve their language ability, this study explored the influence of perinatal factors on the language development of children in Ningxia and identified the unfavorable and favorable factors that influenced language development.MethodsChildren diagnosed in the General Hospital of Ningxia Medical University during 2018–2021 who met the screening criteria for DLD and practical pediatric diagnostic criteria for DLD were enrolled in this study. Perinatal factors (gestational age, weight, sex, delivery mode, maternal age, presence of intrauterine infection, asphyxia) were retrospectively analyzed. The perinatal factors affecting language development were assessed using a one-way analysis of variance (ANOVA).ResultsAmong 1,500 children aged 0–3, 240 cases (16.00%) had language delay. Of these, 122 were male and 118 were female. There were 115 cases of comprehension and expression disorder, 30 cases of articulation disorder, and 90 cases of mixed manifestation. And there were 194 cases with definite intrauterine and perinatal high-risk factors or neonatal diseases, accounting for 80.83% of the total number of children with language delay.ConclusionsIn Ningxia, factors in the neonatal period are the main cause of DLD, followed by fetal and maternal factors. Ischemic encephalopathy is the most common factor.

The experience of pregnancy management by suspicion of fetal intrauterine infection in Ukraine and other countries

TORCH-infection is one of the most important and relevant challenges in obstetrics today. This group of infections refers to diseases for which a woman and a man should be examined before conception for the prevention of intrauterine infection of the fetus. The non-specific clinical manifestations of these diseases are the difficulty to their timely and rapid diagnosis.The objective: an analysis and comparison of the basic criteria for the management of pregnant women with suspected intrauterine infection in Ukraine, countries in Western Europe and the United States.Materials and methods. An analysis of literary publications, protocols, Internet resources devoted to the management of pregnancy in the women with suspected intrauterine infection of the fetus. Results. The protocols and clinical guidelines devoted to the management of pregnancy in the women with suspected intrauterine infection of the fetus in various countries, such as Ukraine, Spain, Great Britain and the United States, were analyzed. According to the literature data, this pathology accounts for a significant percentage and the incidence rates for perinatal infections differ in different countries. So, in Sweden, the prevalence is 117 people per 1000 population, Spain – 100, the Czech Republic – 163, the USA – 50, Russia – 1. The article presents recommendations on screening, management of pregnancy and childbirth in the presence of such infections as toxoplasmosis, rubella, chlamydia, syphilis, hepatitis B, genital herpes, human immunodeficiency virus and bacterial vaginosis in the mother. Some differences have been established in the management of pregnant women with infection pathogens in different countries.Conclusions. The results of the analysis of the literature data demonstrate the necessity for further research on the tactics of pregnancy management in case of intrauterine infection, as well as the features of newborn’ conditions in the presence of intrauterine infection.

Specifics of COVID-19 in pregnant women and their children - a review

Introduction and purpose: The first cases of SARS-CoV-2 infection were recorded in the last months of 2019 in the Chinese city Wuhan. Since then, COVID-19 has spread throughout the world. Still little is known about the perinatal aspects of COVID-19. Objective of this article is to present the course of coronavirus disease in pregnant women with particular emphasis on the occurrence of intrauterine infection and preterm births.Brief description of the state of knowledge: SARS-CoV-2 calling COVID-19 probably comes from bats sold at the Wuhan market. This virus is highly contagious, it spreads from person to person. The most common symptoms of infection include: fever, cough and ground-glass opacity (GGO) in chest radiographs. The analyzes carried out so far show that the course of the disease in pregnant women is similar to that of non-pregnant patients. Women present typical signs of infection. Most researchers also exclude the presence of intrauterine infection, although there have been reports of isolated cases. The percentage of premature births in women with COVID-19 is higher than average.Summary: The course of coronavirus disease in pregnant women is similar to that of other infected women. While most studies do exclude the presence of a vertical infection, there are reports of severe course of the disease and possible vertical infection. Patients with COVID-19 may be more prone to premature delivery, however, to confirm this thesis, it is necessary to examine a larger number of pregnant women.

Патоморфологічні особливості послідів у вагітних із затримкою росту плода

Pregnant women with intrauterine growth restriction (IUGR) have an increased risk of adverse perinatal and long-term complications compared with the birth of children with normal body weight. Thus, IUGR is one of the main challenges for the global health system, especially in poor and developing countries. Morpho-functional studies of the placentas help in determining the causes of IUGR, and therefore, timely prevent complications in pregnant women with IUGR. The objective: The purpose of this study is to investigate various morphometric and pathomorphological changes in the placenta, including inflammatory, in cases of IUGR, and to establish a correlation of these results with the etiology and complications for the fetus. Materials and methods. In the current study, 54 placentas of the fetuses with IUGR (the main group) were compared with 50 placentas of the fetuses with normal development (control group). The criteria for the inclusion of IUGR were gestational age more than 30 weeks and all fetuses with a weight less than 10th percentile for this period of pregnancy. The placenta material was studied pathomorphologically with laboratory screening for infection and inflammation. Similarly, the results were determined for placentas of the fetuses with normal development compared to placentas with IUGR. Results. The placenta study showed the presence of calcification in the case of IUGR, as well as in the case of prolonged pregnancy. However, calcification of the placenta in the case of IUGR was more progressive compared with placenta in the normal pregnancy. In addition, the presence of intrauterine infection and inflammation was observed, which could also lead to an adverse outcome for the further progression of pregnancy with IUGR. Conclusion. A comparative macro- and microscopic pathomorphological study of the placentas in the two groups has shown a significant increase in the pathological changes in all the anatomical structures of the fetuses with IUGR. Key words: Intrauterine growth restriction (IUGR), fetal weight, pathomorphological changes of the placenta.

Эхографическая и клинико-морфологическая оценка плодно-плацентарного комплекса у беременных при плацентарной дисфункции и внутриутробной инфекции

Analysis of ultrasound and clinical and morphological data of 52 cases complicated by placental insufficiency and the presence of intrauterine infection have performed. In all cases, pathomorphological verification of the placenta had carried out. Ultrasound markers-predictors of early complications of placental insufficiency and intrauterine infection had identified.

Activation of Toll-like receptor 5 decreases the attachment of human trophoblast cells to endometrial cells in vitro

Embryo implantation in the uterus involves the trophoblast cells apposing and adhering to, then invading across the epithelium lining of the endometrium. However, ethical concerns regarding experimentation with primary human tissue during this period of life necessitates creation of in vitro models for understanding the basic mechanisms involved. Toll-like receptors (TLRs) play a crucial role in defence against pathogens invading the female reproductive tract. The objective of this study is to establish and optimize an in vitro model for studying human endometrial embryonic interactions and to understand the effect of TLR5 stimulation on the attachment of trophoblast cells to endometrial cells. By using a human telomerase immortalized endometrial epithelial cell line (hTERT-EECs) and choriocarcinoma human trophoblast cells (JAr cells), an in vitro assay of human implantation was established. In order to investigate the impact of TLR5 stimulation on attachment in this assay, bacterial flagellin was applied to the endometrial and trophoblast cells. In order to block TLR5 in the endometrial and trophoblast cells, TLR5 function-blocking antibody was applied to the cells prior to flagellin treatment. The results demonstrated that JAr spheroids attached to hTERT-EECs in a time and concentration-dependent manner. Our results also demonstrated that treatment of endometrial cells with flagellin, suppressed the attachment of JAr spheres to the endometrial cells. Application of TLR5 function-blocking antibody significantly restored the attachment of JAr spheres to the endometrium. These data suggest a novel mechanism by which the presence of intrauterine infection through TLR5 activation may result in implantation failure. These data may provide a new opportunity in the management of infertility cases.

Which factors affect the occurrence of severe cerebral lesions in preterm neonates who are born with intrauterine infection?

The purpose of this study was to evaluate which factors affect the occurrence of neonatal ultrasonographic evidence of severe cerebral lesions in the presence of intrauterine infection. From a cohort of 567 singleton neonates who were born between 24.0 and 31.6 weeks of gestation, we identified the 180 infants with histologic and/or clinical evidence of intrauterine infection. We excluded stillbirths and congenital anomalies. Obstetric and neonatal variables were related to evidence of severe neonatal ultrasonographic cerebral lesions with the use of logistic regression analysis. Severe cerebral lesions were identified in 10% of infants (18/180). After we controlled for variables that were clinically relevant, logistic regression analysis demonstrated that ultrasound evidence of severe neonatal cerebral lesions was associated independently with antenatal administration of corticosteroids (adjusted odds ratio, 0.3; 95% CI, 0.11-0.88; P = .03) and occurrence of placental abruption (adjusted odds ratio, 5.4; 95% CI, 1.4-20.7; P = .02). Antenatal administration of corticosteroids in the presence of intrauterine infection has a protective effect on the risk of ultrasonographic evidence of severe neonatal cerebral lesions.

Disruption of Interleukin-18, but Not Interleukin-1, Increases Vulnerability to Preterm Delivery and Fetal Mortality after Intrauterine Inflammation

Preterm birth is a major contributor of adverse perinatal outcome. Clinical data suggest that an inflammatory response is important in the process leading to preterm labor. By using a recently introduced mouse model of localized intrauterine lipopolysaccharide-induced inflammation, the effect of interleukin (IL)-18 gene disruption and/or IL-18 neutralization as well as combined IL-1alpha/beta gene disruption on inflammation-induced fetal loss was investigated. The frequency of preterm fetal loss was significantly higher in IL-18 knockout mice (58.9%) and in mice administered IL-18-binding protein (59.7%) compared to wild-type controls (34.7%). The rate of fetal loss was not affected by IL-1alpha/beta gene deficiency (38.7%). Decreased IL-18 protein expression combined with elevated IL-12 protein expression in uterine tissue of IL-18 knockout mice and IL-18-binding protein-treated animals was noticed. These data demonstrate that preterm pregnancy loss in response to intrauterine inflammation was enhanced by disruption of the IL-18 gene and/or IL-18 neutralization, events that may relate to exaggerated Th1 responses because of an increased IL-12/IL-18 ratio.

Duration of labor and risk of cerebral white-matter damage in very preterm infants who are delivered with intrauterine infection

The purpose of this study was to assess whether the duration of labor has any effect on the occurrence of cerebral white-matter damage in very preterm infants who are delivered in the presence of intrauterine infection. From a cohort of infants who were born spontaneously at <32 weeks of gestation for whom placental information was available and who survived 7 days from birth, 126 infants had clinical, laboratory, or histologic evidence of intrauterine infection. Among them, variables were compared between those infants with white-matter damage (defined as intraventricular hemorrhage grade 3 plus, periventricular leukomalacia, or ventriculomegaly not associated with hydrocephaly [n = 13]) and those infants without it (n = 113). Comparisons were made with t test, chi-squared test, and survival analysis; a probability value of <.05 was considered significant. There were no differences between the 2 groups in gestational age at delivery and rates of labor or cesarean delivery. Duration of active labor (66 +/- 45 minutes vs 88 +/- 75 minutes; P =.49) and of clinical chorioamnionitis (310 +/- 186 minutes vs 529 +/- 544 minutes; P =.44) were similar in cases with and without neonatal white-matter damage. In 126 infants who were born at <32 weeks of gestation with intrauterine infection, we found no correlation between the duration of labor or clinical chorioamnionitis and neonatal white-matter damage.

199 Diagnostic Prediction Of Maternal Inflammatory Markers For Neonatal Sepsis

Background: Elevated concentration of C-reactive protein(CRP) in the maternal blood is associated with the presence of intrauterine infection. Newborns born of mothers with perinatal infection, whether indicated as chorioamnionitis or positive CRP, have been associated with probable sepsis in early neonatal period. We purport this study to evaluate the diagnostic performance of maternal inflammatory markers, CRP and chorioamnionitis for prediction of neonatal sepsis.Methods: 126 low birth weight newborns(gestation 32±3.2wk, birth weight 1887±623g) and their mothers were recruited. Neonates were divided into sepsis group(65 infants) including both definite(positive blood culture) and probable(negative blood culture but with more than 3 abnormal clinical symptoms) episodes and control(61 infants). Mothers were grouped into histologic chorioamnionitis(n=27), clinical chorioamnionitis(n=18), other infection(n=12), and control(n=69). Mothers were subgrouped into CRP positive(n=32) and CRP negative group(n=94) by CRP 1.86 mg/dL, and calculated relative risk for neonatal sepsis according to maternal condition.Results: Maternal CRP was significantly higher in neonatal sepsis group than in control (2.18±2.79 vs. 1.09±1.29mg/ dl, p=0.0055). Maternal CRP(cutoff value 1.86 mg/dL) had sensitivity 74% and specificity 34% for predicting neonatal sepsis. Maternal CRP positive group had more neonatal sepsis than CRP negative group(69% vs46%, p=0.0245). Relative risk of neonatal sepsis in maternal CRP positive group was 2.61 times(95% CI:1.114– 6.106, p=0.027)) as high as CRP negative group. As maternal CRP increases continuously, the risk for neonatal sepsis increases as 1.31 times(95% CI:1.059–1.626, p=0.013). The relative risk of histologic chorioamnionitis was 2.57, clinical chorioamnionitis 1.21, and other infection 2 for neonatal sepsis, but not significant.Conclusion: The risk of neonatal sepsis significantly increases in the case of positive maternal CRP (more than 1.86 mg/dL). We suggest that maternal CRP should be considered as a risk factor for early neonatal sepsis.

Cytokines, Prostaglandins and Parturition—A Review

The elaboration of cytokines, chemokines and immunomodulatory proteins in the placenta and gestational membranes has been extensively investigated in the context of both normal and abnormal pregnancy and delivery. Patterns of expression of cytokines in the foetal membranes and decidua suggest that inflammatory activation occurs modestly with term labour, but much more robustly in preterm delivery, particularly in the presence of intrauterine infection. Enhanced chemokine expression, particularly evident in deliveries with an infected amniotic cavity, is presumably responsible for recruiting infiltrating leukocytes into the membranes thereby amplifying the inflammatory process and hastening membrane rupture and delivery. Anti-inflammatory cytokines suppress inflammatory reactions in the placenta, but under some circumstances may act in a pro-inflammatory fashion in the membranes. Intracellular signalling by cytokines is modulated by proteins such as SOCS (Silencer Of Cytokine Signalling)-1, -2 and -3. Changes in the abundance of these proteins occur with term labour, implicating them as modulators of cytokine actions around the time of parturition. Prostaglandins, released by the membranes in response to stretch and the actions of pro-inflammatory cytokines, act not only upon the myometrium and cervix, but may also exert paracrine/autocrine effects on cell viability and matrix protein integrity. The localization and regulation of prostanoid isomerases, responsible for converting PGH2 (derived from prostaglandin H synthase-1 and -2) to bioactive prostanoids, are being studied in these tissues, particularly in the context of cytokine interactions. Although the gestational tissues are known to be sources of PGD2, PGJ2 and its derivatives, the regulation of production of these prostaglandins has yet to be studied in any detail and their actions, which may include apoptosis and suppression of inflammation, remain poorly defined. A more complete understanding of these aspects of cytokine-prostaglandin interactions in pregnancy and parturition will, no doubt, unfold as current studies come to fruition.

Regulation of Cytosolic Phospholipase A2 Expression by Cytokines in Human Amnion Cells

The metabolism of arachidonic acid results in the production of prostaglandins (PGs), which are involved in the initiation of labour at term and preterm. The fetal membranes are a source of pro-inflammatory cytokines which promote increased PG biosynthesis via increased release of arachidonic acid and its conversion to biologically active metabolites such as PGE2and PGF2α. In the amnion, the liberation of arachidonic acid from membrane glycerophospholipid stores can be catalysed by cytosolic phospholipase A2(cPLA2). In amnion-derived WISH cells, the addition of tumour-necrosis factor alpha (TNF-α) (50ng/ml) provoked a time-dependent increase in the expression of the cPLA2mRNA which was greatest at 8 and 16h post-treatment (3.62±0.52 and 3.15±0.45-fold of control, n=3). The increase in cPLA2mRNA expression by TNF-α was unaffected by the prior addition of interleukin-4 (IL-4) (10ng/ml), a known inhibitor of prostaglandin endoperoxide H synthase (PGHS)-2 mRNA and protein expression in WISH cells. TNF-α also increased the level of immunoreactive cPLA2protein in a time-dependent manner with the highest levels evident after 8 and 16h. As with the mRNA, cPLA2protein levels were unaffected by pre-incubation with IL-4. The inclusion of the cPLA2-specific inhibitor arachidonyl trifluoromethyl ketone (AACOCF3) resulted in a concentration-dependent inhibition of PGE2biosynthesis in WISH cells treated with TNF-α (>95 per cent at 2μm). We conclude that TNF-α increases the abundance of the cPLA2mRNA and protein in amnion epithelial cells, an effect which plays an important role in amnion PG biosynthesis in the presence of intrauterine infection.

PRETERM LABOR AND PRETERM PREMATURE RUPTURE OF THE MEMBRANES: Diagnosis and Management

Preterm delivery due to preterm labor and pPROM is responsible for most infant morbidity and mortality in the United States. The patient who presents with suspicious symptoms should undergo a thorough evaluation to confirm the diagnosis of either entity and identify a treatable cause. Determination of gestational age, fetal well-being, and the presence of intrauterine infection is a crucial step in subsequent management. Corticosteroid therapy has been demonstrated to be one of the most effective antenatal interventions to reduce infant morbidity and should be administered to patients with preterm labor, if feasible, when fetal pulmonary maturity is absent or undocumented. We recommend a similar protocol regarding gravidas with pPROM remote from term but recognize the need for further study in this area. Acute tocolytic therapy has been demonstrated to offer short-term benefit to enhance corticosteroid effect. However, all of the available tocolytic agents carry significant risks to the mother and fetus. As such, administration of these agents should be given only when the potential benefits outweigh the risks of administration. Evaluation for fetal pulmonary maturity and intrauterine infection, in concert with evaluation of gestational age-dependent risks of prematurity, may be helpful in determining whether tocolysis should be attempted. Adjunctive antibiotic administration has not been shown to reduce maternal or infant morbidity in the face of preterm labor. However, such treatment offers a reduction of chorioamnionitis, prolongation of latency, and a possible reduction of neonatal infectious and gestational age-dependent morbidity in the setting of pPROM remote from term. Finally, current guidelines recommend the administration of intrapartum GBS prophylaxis when preterm birth or prolonged membrane rupture is anticipated if GBS carrier status is unknown or positive. Intrapartum treatment with intravenous penicillin or ampicillin is appropriate.

Acute appendicitis in pregnancy and the occurrence of major intraventricular hemorrhage and periventricular leukomalacia

Infection and endotoxemia have been associated with neurologic injury in the newborn. In addition, recent reports have noted an increased incidence of fetal neurologic injury in the presence of intrauterine infection. Three pregnancies complicated by acute appendicitis and refractory preterm labor resulting in the delivery of neonates who developed early major intraventricular hemorrhage and/or periventricular leukomalacia are described. We hypothesize that extrauterine infections like acute appendicitis may play a role in the occurrence of neonatal neurologic injury.

Diagnosis of intrauterine infection by demonstration of antibody-coated bacteria in the amniotic fluid.

Immunofluorescence examination of amniotic fluid for the occurrence of antibody-coated bacteria was carried out in 72 consecutive women with premature rupture of the fetal membranes to assess this method in the diagnosis of intrauterine infection. Antibody-coated bacteria were demonstrated in 11 women with clinical signs of intrauterine infection, histological amnionitis and heavy growth of one bacterial species. The presence of intrauterine infection was considered possible in another 14 women. One patient had no clinical signs of infection, but positive histological and bacteriological evidence; antibody-coated bacteria were demonstrated in this patient, but not in the remaining 13 women. In 47 women clinical, histological and bacteriological signs of intrauterine infection were absent, and examinations for antibody-coated bacteria were negative in all of them. It is concluded that the demonstration of antibody-coated bacteria in amniotic fluid indicates the presence of intrauterine infection, and the examination may in some cases be positive before the appearance of clinical signs of infection.