Maternal anemia and low birth weight (LBW) may complicate malaria in pregnancy, and placental monocyte infiltrates have been associated with LBW, and anecdotally with anemia. We examined placental pathology from 357 Malawian women. Intervillous monocyte infiltrates were frequent in placental malaria and were not seen in uninfected placentas. Histology was grouped according to a 5-point scale. Dense monocyte infiltrates and presence of intramonocytic malaria pigment were associated with anemia and LBW. Of factors associated with LBW and/or anemia in univariate analysis, gravidity (P ‫ס‬ 0.002), number of antenatal clinic (ANC) visits (P < 0.001), malaria pigment in fibrin (P ‫ס‬ 0.03), and monocyte malaria pigment (P ‫ס‬ 0.0001) remained associated with lower birth weight by multivariate analysis. Associated with maternal anemia were HIV infection (P < 0.0001), intervillous monocyte numbers (P < 0.0001), number of ANC visits (P ‫ס‬ 0.002), and recent febrile symptoms (P ‫ס‬ 0.0001). Pigment-containing placental monocytes are associated with anemia and LBW due to malaria, and may have a causative role in their development.

Malaria in pregnancy predisposes to maternal anemia and low birth weight (LBW). We examined the possible roles of the cytokines tumor necrosis factor alpha (TNF-␣) and gamma interferon (IFN-␥) in these adverse outcomes. We measured cytokine concentrations in placental, peripheral, and cord blood plasma in relation to malaria parasitemia and placental monocyte accumulation in 276 Malawian women. Maternal hemoglobin concentration, human immunodeficiency virus status, and infant birth weight were determined. Concentrations of TNF-␣ in placental blood were correlated with densities of Plasmodium falciparum-infected erythrocytes (P < 0.0001) and of intervillous monocyte infiltrates (P < 0.0001) on placental histology. Peripheral blood TNF-␣ concentrations were relatively low and were weakly associated with malaria. TNF-␣ concentrations were higher in placental blood, where they were strongly associated with malaria. Placental plasma TNF-␣ levels were higher in women who had LBW babies (P ‫؍‬ 0.0027), women with febrile symptoms (P < 0.0001), and teenage mothers (P ‫؍‬ 0.04) than in other women. The presence of TNF-␣ in cord blood was not associated with malaria infection. IFN-␥ levels were infrequently elevated, and elevated IFN-␥ levels were not associated with poor pregnancy outcomes. Placental production of TNF-␣, but not of IFN-␥, may be implicated in impaired fetal growth in Malawian women.

Background: A study was undertaken to determine the impact of respiratory syncytial virus (RSV) infection, both in hospital and the community, on healthcare utilisation and respiratory morbidity in prematurely born infants and to identify risk factors for symptomatic RSV infection. Methods: A hospital and community follow up study was undertaken of 126 infants born before 32 weeks of gestational age. Healthcare utilisation (hospital admissions and general practitioner attendances) in the first year, respiratory morbidity at follow up (wheeze and cough documented by parent completed diary cards), and RSV positive lower respiratory tract infections (LRTIs) were documented. Nasopharyngeal aspirates were obtained for immunofluorescence and culture for RSV whenever the infants had an LRTI, either in the community or in hospital. Results: Forty two infants had an RSV positive LRTI (RSV group), 50 had an RSV negative LRTI (RSV negative LRTI group), and 32 infants had no LRTI (no LRTI group). Compared with the RSV negative LRTI and the no LRTI groups, the RSV group required more admissions (p = 0.392, p,0.001) and days in hospital (p = 0.049, p = 0.006) and had more cough (p = 0.05, p = 0.038) and wheeze (p = 0.003, p = 0.003) at follow up. Significant risk factors for symptomatic RSV LRTI were number of siblings (p = 0.035) and maternal smoking in pregnancy (p = 0.005), for cough were number of siblings (p = 0.002) and RSV LRTI (p = 0.02), and for wheeze was RSV LRTI (p = 0.019). Conclusion: RSV infection, even if hospital admission is not required, is associated with increased subsequent respiratory morbidity in prematurely born infants.

These results emphasise the importance of ongoing inflammation in the development of BPD; ETCO levels, rather than lung function test results, were the more accurate predictor of BPD development.

In prematurely born infants, routinely exposed to antenatal steroids and postnatal surfactant, chorioamnionitis was not associated with worse lung function or more severe BPD.