Chorioamnionitis and Five-Year Neurodevelopmental Outcome in Preterm Infants

Ylijoki, Milla; Lehtonen, Liisa; Lind, Annika; Ekholm, Eeva; Lapinleimu, Helena; Kujari, Harry; Haataja, Leena

doi:10.1159/000446236

Cited by 23 publications

(27 citation statements)

References 24 publications

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“…119 Yliloki et al recently reported the lack of association between CCA and neurodevelopmental problems in very preterm infants. 120 In contrast, HCA was associated with a slightly less optimal performance at 5 years of age, although, in their opinion, further studies are needed to verify the clinical significance of these findings. Previously, in a systematic review by the same group that included 84 original papers, they concluded that the majority of the studies did not support the hypothesis that CA poses a direct risk on the central nervous system of preterm infants.…”

Section: Brain Injurymentioning

confidence: 87%

Chorioamnionitis and neonatal morbidity: current perspectives

Henríquez¹,

Rodrigo²

2017

RRN

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Abstract:The term chorioamnionitis (CA) is commonly used to refer to different clinical or pathological conditions characterized by an infectious and/or inflammatory process that affects primarily the chorioamniotic membranes, but also the amniotic fluid, vessels of the chorionic plate, and, eventually, the umbilical cord (funisitis) and the fetus. Its incidence is higher at lower gestational ages, and the main mechanism is believed to be the ascending bacterial infection from the maternal genital tract. It can be diagnosed by clinical criteria, amniotic fluid examination for inflammatory mediators, and/or isolation of microorganisms, or by histopathological examination of the placenta. CA is an important cause of stillbirth and is related to an increased incidence of premature rupture of membranes, preterm delivery, and adverse maternal and neonatal outcomes such as early-onset neonatal sepsis and necrotizing enterocolitis. An independent causal association to other neonatal morbidities is more controversial. The heterogeneity in the diagnostic criteria and in the operative definitions for morbidity makes comparison of studies difficult, and results are inconsistent. In addition, the intensity and duration of the process are usually not considered. For all these reasons, evidence-based recommendations for the management of mother and infant under these circumstances are difficult to establish, and clinical practice varies widely.

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Section: Brain Injurymentioning

confidence: 87%

Chorioamnionitis and neonatal morbidity: current perspectives

Henríquez¹,

Rodrigo²

2017

RRN

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“…FIRS is associated with high rates of long-term morbidities such as cerebral palsy and developmental delay. 19–22 But a recent report by PIPARI study collaborators 23 suggests that clinical chorioamnionitis does not have a major independent role in the pathogenesis of neurodevelopmental problems in very preterm infants. The authors 24 argue that rather than chorioamnionitis other underlying pathologies behind preterm delivery may be contributory to preterm brain injury.…”

Section: Discussionmentioning

confidence: 99%

Preterm infant outcomes in relation to the gestational age of onset and duration of prelabour rupture of membranes: a retrospective cohort study

Pharande

Abdel-Latif

Bajuk

et al. 2017

bmjpo

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ObjectiveTo determine the hospital outcomes of liveborn infants at 23–31 weeks following prelabour preterm rupture of membranes (PPROM).MethodA regional retrospective cohort study of 4454 infants of 23–31 weeks’ gestation admitted to a tertiary neonatal network between 2007 and 2011. Primary outcome was the composite chronic lung disease (CLD) or mortality at discharge.Results225 (5%) neonates had a history of PPROM occurring prior to 24+0 weeks (Early-PPROM), 829 (19%) had a history of PPROM at or after 24+0 weeks’ gestation (Late-PPROM) and 3400 (76%) had no history of PPROM (No-PPROM). In comparison to No-PPROM, Early-PPROM group had higher CLD/mortality in infants born at 23–27 weeks (OR 1.95; 95% CI 1.34 to 2.85) and 28–31 weeks (OR 4.98; 95% CI 2.99 to 8.28). Within Early-PPROM group, the latency of PPROM >14 days had lower CLD/mortality in comparison to latency ≤14 days (57.6% vs 77%, OR 0.40; 95% CI 0.21 to 0.76). Late-PPROM group had significantly lower CLD/mortality in comparison to No-PPROM group at 23–27 weeks (OR 0.50; 95% CI 0.37 to 0.69) and 28–31 weeks (OR 0.50; 95% CI 0.36 to 0.71). Within Late-PPROM group, latency >14 days was associated with an increased CLD/mortality in 28–31 weeks (14.1% vs 5.4%, OR 2.88; 95% CI 1.31 to 6.38).ConclusionsEarly-PPROM prior to 24 weeks’ gestation had high incidence of CLD/mortality even after correcting for gestational age. Late-PPROM at or after 24 weeks had lower CLD/mortality compared with No-PPROM. Latency >14 days in Late-PPROM group at 28–31 week group increased the odds of CLD/mortality.

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“…This disorder is a tremendous burden on society and families. Studies show that maternal chorioamnionitis[ 15 ], maternal preeclampsia[ 16 ], maternal age >35 years, a low Apgar score at 5 minutes, preterm birth[ 17 ], low birth weight, periventricular/intraventricular hemorrhage[ 18 ], and bronchopulmonary dysplasia (BPD) are associated with CP. Among recent studies focusing on the relationship between maternal obesity and CP in offspring[ 9 , 12 , 13 , 17 , 19 – 22 ], two studies showed that maternal weight during pregnancy is associated with CP in offspring[ 23 , 24 ], and other studies indicated a significant association between maternal obesity and CP in children[ 9 , 12 , 13 , 20 , 21 ].…”

Section: Introductionmentioning

confidence: 99%

Association between maternal overweight or obesity and cerebral palsy in children: A meta-analysis

Xiao

Huang

et al. 2018

PLoS ONE

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ContextThere is no consensus regarding the association between maternal obesity or overweight and cerebral palsy (CP) in children.ObjectivesTo investigate whether maternal obesity or overweight is associated with CP and identify the factors that explain the differences in the study results.Data sourcesWe conducted a meta-analysis of studies published in English with titles or abstracts that discussed the relationships between maternal obesity or overweight and CP before August 23, 2017, using Ovid Medline, EMBASE and Web of Science.Study selectionOf 2699 initially identified studies, 8 studies that addressed the association between maternal obesity and CP met our final inclusion criteria.Data extractionInformation from the individual studies was abstracted using standardized forms by 2 independent observers who were blinded to the authors’ names and journal titles.Data synthesisAccording to a random effects model, maternal overweight was significantly associated with CP in offspring [RR = 1.29 (95% CI, 1.04–1.60), heterogeneity (I2 = 45.5%, P = 0.103)]; maternal obesity was significantly associated with CP in offspring [RR = 1.45 (95% CI, 1.25–1.69), heterogeneity (I2 = 24.1%, P = 0.253)]; and maternal obesity III was significantly associated with CP in offspring [RR = 2.25 (95% CI, 1.82–2.79), heterogeneity (I2 = 0%, P = 0.589)]. However, maternal underweight was not significantly associated with CP in offspring [RR = 1.11 (95% CI, 0.88–1.38), low heterogeneity (I2 = 0%, P = 0.435)]. Factors that explained the differences in the meta-analysis results included study design, study location, and whether individual studies adjusted for potential confounders.ConclusionThis study suggests that maternal obesity and overweight increase the risk of CP in offspring. Further studies are required to confirm these results and determine the influence of variables across studies.

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Chorioamnionitis and Five-Year Neurodevelopmental Outcome in Preterm Infants

Cited by 23 publications

References 24 publications

Chorioamnionitis and neonatal morbidity: current perspectives

Chorioamnionitis and neonatal morbidity: current perspectives

Preterm infant outcomes in relation to the gestational age of onset and duration of prelabour rupture of membranes: a retrospective cohort study

Association between maternal overweight or obesity and cerebral palsy in children: A meta-analysis

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