Clinical and Experimental Pediatrics

The Korean Pediatric Society (대한소아청소년과학회)
권호 표지
DOI QR코드

DOI QR Code

Chorioamnionitis: Is a major player in the development of bronchopulmonary dysplasia?

  • Choi, Chang Won (Department of Pediatrics, Seoul National University College of Medicine)
  • Received : 2017.04.11
  • Accepted : 2017.06.14
  • Published : 2017.07.15
Download PDF
⟨ Previous Next ⟩

Abstract

Chorioamnionitis is an inflammation in the fetal membranes or placenta. When chorioamnionitis develops, fetal lungs are exposed to inflammatory cytokines and mediators via amniotic fluid. Because inflammation plays a pivotal role in the development of bronchopulmonary dysplasia (BPD), a chronic lung disease of prematurity, fetal lung inflammation induced by chorioamnionitis has been considered to be one of the major pathogenetic factors for BPD. Although there have been a number of studies that demonstrated the relationship between chorioamnionitis and BPD, there are still controversies on this issue. The controversies on the relationship between chorioamnionitis and BPD arise from not-unified definitions of chorioamnionitis and BPD, different study populations, and the proportion of contribution between inflammation and infectious microorganisms. The publication bias also contributes to the controversies. Clinical trials targeting chorioamnionitis or microorganisms that cause chorioamnionitis will answer on the actual relationship between chorioamnionitis and BPD and provide a novel prophylactic strategy against BPD based on that relationship.

Keywords

References

  1. 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. https://doi.org/10.1067/mob.2000.109035
  2. Ramsey PS, Lieman JM, Brumfield CG, Carlo W. Chorioamnionitis increases neonatal morbidity in pregnancies complicated by preterm premature rupture of membranes. Am J Obstet Gynecol 2005;192:1162-6. https://doi.org/10.1016/j.ajog.2004.11.035
  3. Dempsey E, Chen MF, Kokottis T, Vallerand D, Usher R. Outcome of neonates less than 30 weeks gestation with histologic chorioamnionitis. Am J Perinatol 2005;22:155-9. https://doi.org/10.1055/s-2005-865020
  4. Andrews WW, Goldenberg RL, Faye-Petersen O, Cliver S, Goepfert AR, Hauth JC. The Alabama Preterm Birth study: polymorphonuclear and mononuclear cell placental infiltrations, other markers of inflammation, and outcomes in 23- to 32-week preterm newborn infants. Am J Obstet Gynecol 2006;195:803-8. https://doi.org/10.1016/j.ajog.2006.06.083
  5. Jobe AH. Antenatal associations with lung maturation and infection. J Perinatol 2005;25 Suppl 2:S31-5. https://doi.org/10.1038/sj.jp.7211317
  6. Watterberg KL, Demers LM, Scott SM, Murphy S. Chorioamnionitis and early lung inflammation in infants in whom bronchopulmonary dysplasia develops. Pediatrics 1996;97:210-5.
  7. Plakkal N, Soraisham AS, Trevenen C, Freiheit EA, Sauve R. Histological chorioamnionitis and bronchopulmonary dysplasia: a retrospective cohort study. J Perinatol 2013;33:441-5. https://doi.org/10.1038/jp.2012.154
  8. Van Marter LJ, Dammann O, Allred EN, Leviton A, Pagano M, Moore M, et al. Chorioamnionitis, mechanical ventilation, and postnatal sepsis as modulators of chronic lung disease in preterm infants. J Pediatr 2002;140:171-6. https://doi.org/10.1067/mpd.2002.121381
  9. Groneck P, Gotze-Speer B, Oppermann M, Eiffert H, Speer CP. Association of pulmonary inflammation and increased microvascular permeability during the development of bronchopulmonary dysplasia: a sequential analysis of inflammatory mediators in respiratory fluids of high-risk preterm neonates. Pediatrics 1994;93:712-8.
  10. Lahra MM, Beeby PJ, Jeffery HE. Intrauterine inflammation, neonatal sepsis, and chronic lung disease: a 13-year hospital cohort study. Pediatrics 2009;123:1314-9. https://doi.org/10.1542/peds.2008-0656
  11. Glaser K, Speer CP. Pre and postnatal inflammation in the pathogenesis of bronchopulmonary dysplasia. In: Bhandari V, editor. Bronchopulmonary dysplasia. Philadephia (PA): Humana Press, 2016:55-77.
  12. Kramer BW, Kallapur S, Newnham J, Jobe AH. Prenatal inflammation and lung development. Semin Fetal Neonatal Med 2009; 14:2-7. https://doi.org/10.1016/j.siny.2008.08.011
  13. Kramer BW, Ladenburger A, Kunzmann S, Speer CP, Been JV, van Iwaarden JF, et al. Intravenous lipopolysaccharide-induced pulmonary maturation and structural changes in fetal sheep. Am J Obstet Gynecol 2009;200:195.e1-10.
  14. Choi CW, Kim BI, Hong JS, Kim EK, Kim HS, Choi JH. Bronchopulmonary dysplasia in a rat model induced by intra-amniotic inflammation and postnatal hyperoxia: morphometric aspects. Pediatr Res 2009;65:323-7. https://doi.org/10.1203/PDR.0b013e318193f165
  15. Choi CW, Lee J, Oh JY, Lee SH, Lee HJ, Kim BI. Protective effect of chorioamnionitis on the development of bronchopulmonary dysplasia triggered by postnatal systemic inflammation in neonatal rats. Pediatr Res 2016;79:287-94. https://doi.org/10.1038/pr.2015.224
  16. Husain AN, Siddiqui NH, Stocker JT. Pathology of arrested acinar development in postsurfactant bronchopulmonary dysplasia. Hum Pathol 1998;29:710-7. https://doi.org/10.1016/S0046-8177(98)90280-5
  17. Viscardi RM, Manimtim WM, Sun CC, Duffy L, Cassell GH. Lung pathology in premature infants with Ureaplasma urealyticum infection. Pediatr Dev Pathol 2002;5:141-50.
  18. Viscardi R, Manimtim W, He JR, Hasday JD, Sun CC, Joyce B, et al. Disordered pulmonary myofibroblast distribution and elastin expression in preterm infants with Ureaplasma urealyticum pneumonitis. Pediatr Dev Pathol 2006;9:143-51. https://doi.org/10.2350/10-05-0112.1
  19. Erdemir G, Kultursay N, Calkavur S, Zekioglu O, Koroglu OA, Cakmak B, et al. Histological chorioamnionitis: effects on premature delivery and neonatal prognosis. Pediatr Neonatol 2013;54: 267-74. https://doi.org/10.1016/j.pedneo.2013.03.012
  20. Soraisham AS, Trevenen C, Wood S, Singhal N, Sauve R. Histological chorioamnionitis and neurodevelopmental outcome in preterm infants. J Perinatol 2013;33:70-5. https://doi.org/10.1038/jp.2012.49
  21. Lahra MM, Beeby PJ, Jeffery HE. Maternal versus fetal inflammation and respiratory distress syndrome: a 10-year hospital cohort study. Arch Dis Child Fetal Neonatal Ed 2009;94:F13-6.
  22. Speer CP. Neonatal respiratory distress syndrome: an inflammatory disease? Neonatology 2011;99:316-9. https://doi.org/10.1159/000326619
  23. Been JV, Rours IG, Kornelisse RF, Jonkers F, de Krijger RR, Zimmermann LJ. Chorioamnionitis alters the response to surfactant in preterm infants. J Pediatr 2010;156:10-5.e1. https://doi.org/10.1016/j.jpeds.2009.07.044
  24. Choi CW, Kim BI, Kim HS, Park JD, Choi JH, Son DW. Increase of interleukin-6 in tracheal aspirate at birth: a predictor of subsequent bronchopulmonary dysplasia in preterm infants. Acta Paediatr 2006;95:38-43.
  25. Hartling L, Liang Y, Lacaze-Masmonteil T. Chorioamnionitis as a risk factor for bronchopulmonary dysplasia: a systematic review and meta-analysis. Arch Dis Child Fetal Neonatal Ed 2012;97:F8-17. https://doi.org/10.1136/adc.2010.210187
  26. Kim SY, Choi CW, Jung E, Lee J, Lee JA, Kim H, et al. Neonatal morbidities associated with histologic chorioamnionitis defined based on the site and extent of inflammation in very low birth weight infants. J Korean Med Sci 2015;30:1476-82. https://doi.org/10.3346/jkms.2015.30.10.1476
  27. Goldenberg RL, Andrews WW, Goepfert AR, Faye-Petersen O, Cliver SP, Carlo WA, et al. The Alabama Preterm Birth Study: umbilical cord blood Ureaplasma urealyticum and Mycoplasma hominis cultures in very preterm newborn infants. Am J Obstet Gynecol 2008;198:43.e1-5. https://doi.org/10.1016/j.ajog.2007.07.033
  28. Inatomi T, Oue S, Ogihara T, Hira S, Hasegawa M, Yamaoka S, et al. Antenatal exposure to Ureaplasma species exacerbates bronchopulmonary dysplasia synergistically with subsequent prolonged mechanical ventilation in preterm infants. Pediatr Res 2012;71: 267-73. https://doi.org/10.1038/pr.2011.47
  29. Thome U, Gotze-Speer B, Speer CP, Pohlandt F. Comparison of pulmonary inflammatory mediators in preterm infants treated with intermittent positive pressure ventilation or high frequency oscillatory ventilation. Pediatr Res 1998;44:330-7. https://doi.org/10.1203/00006450-199809000-00011
  30. Bancalari E, Claure N. Bronchopulmonary dysplasia: definitions and epidemiology. In: Bhandari V, editor. Bronchopulmonary dysplasia. Philadephia (PA): Humana Press, 2016:167-82.
  31. Beam KS, Aliaga S, Ahlfeld SK, Cohen-Wolkowiez M, Smith PB, Laughon MM. A systematic review of randomized controlled trials for the prevention of bronchopulmonary dysplasia in infants. J Perinatol 2014;34:705-10. https://doi.org/10.1038/jp.2014.126
  32. Lowe J, Watkins WJ, Edwards MO, Spiller OB, Jacqz-Aigrain E, Kotecha SJ, et al. Association between pulmonary ureaplasma colonization and bronchopulmonary dysplasia in preterm infants: updated systematic review and meta-analysis. Pediatr Infect Dis J 2014;33:697-702. https://doi.org/10.1097/INF.0000000000000239
  33. Viscardi RM, Hasday JD. Role of Ureaplasma species in neonatal chronic lung disease: epidemiologic and experimental evidence. Pediatr Res 2009;65(5 Pt 2):84R-90R. https://doi.org/10.1203/PDR.0b013e31819dc2f9
  34. Namba F, Hasegawa T, Nakayama M, Hamanaka T, Yamashita T, Nakahira K, et al. Placental features of chorioamnionitis colonized with Ureaplasma species in preterm delivery. Pediatr Res 2010;67:166-72. https://doi.org/10.1203/PDR.0b013e3181c6e58e
  35. Jung E, Choi CW, Kim SY, Sung TJ, Kim H, Park KU, et al. Coexistence of Ureaplasma and chorioamnionitis is associated with prolonged mechanical ventilation. Pediatr Int 2017;59:34-40. https://doi.org/10.1111/ped.13072
  36. Hermansen MC, Hermansen MG. Perinatal infections and cerebral palsy. Clin Perinatol 2006;33:315-33. https://doi.org/10.1016/j.clp.2006.03.002
  37. Wang EE, Cassell GH, Sanchez PJ, Regan JA, Payne NR, Liu PP. Ureaplasma urealyticum and chronic lung disease of prematurity: critical appraisal of the literature on causation. Clin Infect Dis 1993;17 Suppl 1:S112-6. https://doi.org/10.1093/clinids/17.Supplement_1.S112
  38. Schelonka RL, Katz B, Waites KB, Benjamin DK Jr. Critical appraisal of the role of Ureaplasma in the development of bronchopulmonary dysplasia with metaanalytic techniques. Pediatr Infect Dis J 2005;24:1033-9. https://doi.org/10.1097/01.inf.0000190632.31565.83
  39. Viscardi RM, Kallapur SG. Role of ureaplasma respiratory tract colonization in bronchopulmonary dysplasia pathogenesis: current concepts and update. Clin Perinatol 2015;42:719-38. https://doi.org/10.1016/j.clp.2015.08.003
  40. Grigsby PL, Novy MJ, Sadowsky DW, Morgan TK, Long M, Acosta E, et al. Maternal azithromycin therapy for Ureaplasma intraamniotic infection delays preterm delivery and reduces fetal lung injury in a primate model. Am J Obstet Gynecol 2012;207:475.e1-475.e14.
  41. Acosta EP, Grigsby PL, Larson KB, James AM, Long MC, Duffy LB, et al. Transplacental transfer of Azithromycin and its use for eradicating intra-amniotic ureaplasma infection in a primate model. J Infect Dis 2014;209:898-904. https://doi.org/10.1093/infdis/jit578
  42. Miura Y, Payne MS, Keelan JA, Noe A, Carter S, Watts R, et al. Maternal intravenous treatment with either azithromycin or solithromycin clears Ureaplasma parvum from the amniotic fluid in an ovine model of intrauterine infection. Antimicrob Agents Chemother 2014;58:5413-20. https://doi.org/10.1128/AAC.03187-14
  43. Nair V, Loganathan P, Soraisham AS. Azithromycin and other macrolides for prevention of bronchopulmonary dysplasia: a systematic review and meta-analysis. Neonatology 2014;106:337-47. https://doi.org/10.1159/000363493

Cited by

  1. Small for gestational age very preterm infants present a higher risk of developing bronchopulmonary dysplasia vol.12, pp.4, 2019, https://doi.org/10.3233/npm-180129
  2. The Relationship between Histological Chorioamnionitis and Bronchopulmonary Dysplasia in Low-Birth Weight Infants: Changes of C-Reactive Protein in Bronchopulmonary Dysplasia vol.30, pp.1, 2017, https://doi.org/10.14734/pn.2019.30.1.8
  3. Bronchopulmonary dysplasia: how can we improve its outcomes? vol.62, pp.10, 2017, https://doi.org/10.3345/kjp.2019.00178
  4. Recent advances in our understanding of the mechanisms of lung alveolarization and bronchopulmonary dysplasia vol.317, pp.6, 2017, https://doi.org/10.1152/ajplung.00369.2019
  5. Analysis ofClinical Risk Factors, Complications and Prevention Strategies for Bronchopulmonary Dysplasia in Preterm Infants with Gestational Age < 32 Weeks vol.10, pp.4, 2017, https://doi.org/10.12677/acm.2020.104092
  6. Prediction Model for Bronchopulmonary Dysplasia in Preterm Newborns vol.8, pp.10, 2021, https://doi.org/10.3390/children8100886