Clinical and Experimental Pediatrics

The Korean Pediatric Society (대한소아청소년과학회)
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The Effect of Histologic Chorioamnionitis on the Development of Respiratory Distress Syndrome and Chronic Lung Disease in Preterm Infants

조산아에서 조직학적 융모양막염이 호흡곤란 증후군 및만성 폐질환의 발병에 미치는 영향

Jo, Hui-Seung;Kim, Byeong-Il;Choe, Chang-Won;Park, Jun-Dong;Kim, Jong-Jae;Choe, Jung-Hwan
조희승;김병일;최창원;박준동;김종재;최중환

  • Published : 20040000
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Abstract

Purpose:Histologic chorioamnionitis may play a role in the development of respiratory distress syndrome(RDS) and chronic lung disease(CLD) independently or through its association with preterm birth. We investigated the relationship between histologic chorioamnionitis and clinical complications including, RDS and CLD, of preterm infants. Methods:Clinical data were collected retrospectively from 478 preterm infants(gestational period$\leq$34 weeks) who were admitted to the neonatal intensive care unit(NICU) in Seoul National University Children's Hospital from January 1993 to December 2000. Results:Histologic chorioamnionitis(CA) was observed in 210 of 478 infants(44%). Lower gestational period was detected in CA(＋) group($31^+^1\pm2^+^2$ weeks vs. $30^+^1\pm2^+^3$ weeks). CA(＋) group had decreased incidence of RDS(38.4% vs. 28.1%)[odds ratio, OR 0.35(P=0.0004, 95% confidence intervals, CI 0.19-0.63)], and increased incidence of CLD(7.5% vs. 13.3%)[OR 1.95(P=0.047, 95% CI 1.01-3.79)] combined much more “atypical CLD”(10.5% vs. 55.6%). CA(＋) group had decreased incidence of patent ductus arteriosus(33.3% vs. 25.4%)[OR 0.37(P=0.003, 95% CI 0.19-0.71)]. There was no difference between the two groups in birth weight. Conclusion:It is suggested that intrauterine infections and fetal inflammatory responses might play a role in the outcome of preterm infants, and histologic chorioamnionitis is an isolated risk factor in the development of RDS and CLD of the preterm infants. (Korean J Pediatr 2004;47:150-156)

Keywords

References

  1. Hollander D. Diagnosis of chorioamnionitis. Clin Obstet Gynecol 1986;29:816-25
  2. Salafia CM, Weigl C, Silberman L. The prevalence and distribution of acute placental inflammation in uncomplicated term pregnancies. Obstet Gynecol 1989;73:383-9
  3. Russell P. Inflammatory lesions of the human placenta. I. clinical significance of acute chorioamnionitis. Am J Diagn Gynecol Obstet 1979;1:127-37
  4. Guzick DS, Winn K. The association of chorioamnionitis with preterm delivery. Obstet Gynecol 1985;65:11-6
  5. Hillier SL, Martius J, Krohn M, Kiviat N, Holmes KK, Eschenbach DA. A case-control study of chorioamnionic infection and histologic chorioamnionitis in prematurity. N Engl J Med 1988;319:972-8
  6. Gibbs RS, Romero R, Hilar SL, Eschenbach DA, Sweet RL. A review of premature birth and subclinical infection. Am J Obstet Gynecol 1992;166:1515-28
  7. Elimian A, Verma U, Beneck D, Cipriano R, Visintainer P, Tejani N. Histologic chorioamnionitis, antenatal steroids, and perinatal outcomes. Obstet Gynecol 2000;96:333-6
  8. Yoon BH, Romero R, Park JS, Kim M, Oh SY, Kim CJ, et al. The relationship among inflammatory lesions of the umbilical cord(funisitis), umbilical cord plasma interleukin 6 concentration, amniotic fluid infection, and neonatal sepsis. Am J Obstet Gynecol 2000;183:1124-9
  9. Alexander JM, Gilstrap LC, Cox SM. Clinical chorioamnionitis and the prognosis for very low birth weight infants. Obstet Gynecol 1998;91:725-9
  10. Lyon A. Chronic lung disease of prematurity. The role of intra-uterine infection. Eur J Pediatr 2000;159:798-802
  11. Jobe AH, Bancalari E. Bronchopulmonary dysplasia. Am J Respir Crit Care Med 2001;163:1723-9
  12. Speer CP. New insight into the pathogenesis of pulmonary inflammation in preterm infants. Biol Neonate 2001;79:205- 9
  13. Salafia CM, Minior VK, Rosenkrantz TS, Pezzullo JC, Popek EJ, Cusick W, et al. Maternal, placental, and neonatal associations with early germinal matrix/intraventricular hemorrhage in infants born before 32 weeks' gestation. Am J Perinatol 1995;12:429-36
  14. De Felice C, Toti P, Laurini RN, Stumpo M, Picciolini E, Todros T, et al. Early neonatal brain injury in histologic chorioamnionitis. J Pediatr 2001;138:101-4
  15. Toti P, De Felice C. Chorioamnionitis and fetal/neonatal brain injury. Biol Neonate 2001;79:201-4
  16. Yoon BH, Kim CJ, Romero R, Jun JK, Park KH, Choi ST, et al. Experimentally induced intrauterine infection causes fetal brain white matter lesions in rabbits. Am J Obstet Gynecol 1997;177:797-802
  17. Koh KS, Chan FH, Monfared AH. The changing perinatal and maternal outcome in chorioamnionitis. Obstet Gynecol 1979;53:730-4
  18. Dexter SC, Pinar H, Malee MP, Hogan J, Carpenter MW, Vohr BR. Outcome of very low birth weight infants with histopathologic chorioamnionitis. Obstet Gynecol 2000;96: 172-7
  19. Watterberg ML, Demers LM, Scott SM. Chorioamnionitis and early lung inflammation in infants in whom bronchopulmonary dysplasia develops. Pediatrics 1996;97:210-5
  20. Shimoya K, Taniguchi T, Matsuzaki N, Moriyama A, Murata Y, Kitajima H, et al. Chorioamnionitis decreased incidence of respiratory distress syndrome by elevating fetal interleukin-6 serum concentration. Hum Reprod 2000;15: 2234-40
  21. Morales WJ. The effect of chorioamnionitis on the developmental outcome of preterm infants at one year. Obstet Gynecol 1987;70:183-6
  22. Rojas MA, Gonzalez A, Bancalari E, Claure N, Poole C, Silva-Neto G. Changing trends in the epidemiology and pathogenesis of neonatal chronic lung disease. J Pediatr 1995;126:605-10
  23. Hack M, Merkatz IR. Preterm delivery and low birth weight - a dire legacy(editorial). N Engl J Med 1995;333: 1772-4
  24. Widholm O, Mayer B, Numers CV. Inflammation of the umbilical cord in cases of foetal asphyxia of unknown clinical etiology. Gynaecologia 1963;155:385-99
  25. Benirschke K, Kaufmann P. Pathology of the human placenta, 3rd ed. New York, Springer-Verlag, 1995;537-623
  26. Dammann O, Leviton A. Maternal intrauterine infection, cytokines, and brain damage in the preterm newborn. Pediatr Res 1997;42:1-8
  27. Gomez R, Romero R, Ghezzi F, Yoon BH, Mazor M, Berry SM. The fetal inflammatory response syndrome. Am J Obstet Gynecol 1998;179:194-202
  28. Kim BI, Park JD, Yoon BH. Interleukin-8 and neutrophils in the tracheobronchial aspirate at birth and the risk for the development of chronic lung disease of prematurity. Prenat Neonat Med 2000;5:375-82
  29. Stallmach T, Karolyi L. Augmentation of fetal granulopoiesis with chorioamnionitis during the second trimester of gestation. Hum Pathol 1994;25:244-7
  30. Dammann O, Leviton A. Infection remote from the brain, neonatal white matter damage, and cerebral palsy in the preterm infant. Semin Pediatr Neurol 1998;5:190-201
  31. Wu YW, Colford JM. Chorioamnionitis as a risk factor for cerebral palsy. A meta-analysis. JAMA 2000;284:1417-24
  32. Zhang J, Kraus FT, Aquino TI. Chorioamnionitis:a comparative histologic, bacteriologic, and clinical study. Int J Gynecol Pathol 1985;4:1-10
  33. Fujimura M, Kitajima H, Nakayama M. Increased leukocyte elastase of the tracheal aspirate at birth and neonatal pulmonary emphysema. Pediatrics 1993;92:564-9
  34. Matsuda T, Nakajima T, Hattori S, Hanatani K, Fukazawa Y, Kobayashi K, et al. Necrotizing funisitis:Clinical significance and association with chronic lung disease in premature infants. Am J Obstet Gynecol 1997;177:1402-7