Chorioamnionitis with a fetal inflammatory response is associated with higher neonatal mortality, morbidity, and resource use than chorioamnionitis displaying a maternal inflammatory response only

Lau, Jacqueline; Magee, Fergall; Qiu, Zhenguo; Houbé, Jill; Dadelszen, Peter von; Lee, Shoo K.

doi:10.1016/j.ajog.2005.01.017

Cited by 176 publications

(135 citation statements)

References 19 publications

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“…Suspected sepsis was diagnosed in the presence of clinical suspicion of sepsis (signs/symptoms of which included lethargy, apnea, respiratory distress, hypoperfusion and shock) with support from laboratory results. Laboratory criteria were based on modification of the criteria of Rodwell et al (23,25) when Ն2 of the following were observed: absolute neutrophil count (ANC) Ͻ7,500/mL or Ͼ14,500/mL, absolute band count (ABC) Ͼ1,500/mL, immature/total neutrophil ratio (I:T) ratio Ͼ16%, platelet count Ͻ150,000 cells/mm 3 or abnormal spinal tap (23). Early-onset neonatal sepsis was dichotomized into present (when sepsis was either Figure 1.…”

Section: Methodsmentioning

confidence: 99%

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Proteomic Biomarkers of Intra-amniotic Inflammation: Relationship with Funisitis and Early-onset Sepsis in the Premature Neonate

Buhimschi

Abdel-Razeq

et al. 2007

Pediatr Res

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ABSTRACT:Our goal was to determine the relationship between 4 amniotic fluid (AF) proteomic biomarkers (human neutrophil defensins 2 and 1, calgranulins C and A) characteristic of intra-amniotic inflammation, and funisitis and early-onset sepsis in premature neonates. The mass restricted (MR) score was generated from AF obtained from women in preterm labor (n ϭ 123). The MR score ranged from 0 -4 (none to all biomarkers present). Funisitis was graded histologically and interpreted in relation to the MR scores. Neonates (n ϭ 97) were evaluated for early-onset sepsis. There was significant correlation between the severity of AF inflammation and the presence (53/123) and grades of funisitis (p Ͻ 0.001). Funisitis occurred independently of the amniocentesis-to-delivery interval or status of the membranes and was best predicted by an MR score 3-4 and an earlier gestational age (GA) at delivery. Neonates born to women with an MR score 3-4 had an increased incidence of suspected/confirmed sepsis, even after adjusting for GA at birth. Calgranulin C had the highest association with clinically significant funisitis, while calgranulin A had the strongest association with early-onset sepsis. To conclude, AF proteomic analysis shows that women with MR scores 3-4 are more likely to have histologic funisitis, and deliver neonates with early-onset sepsis. the rate of preterm birth (PTB) has actually increased over the past 20 y (1). More than 500,000 preterm infants were born in the United States in 2004 (1). Interventions to prevent PTB and its consequences for the fetus should predominantly be targeted at the prevention, early recognition and treatment of several risk factors including intra-amniotic inflammation/ infection (2).Robust scientific evidence has confirmed that when intraamniotic inflammation secondary to, or independent of infection is superimposed upon prematurity, the consequences for the neonate can prove devastating (3,4). This association can be explained by an inflammatory cytokine cascade that seems to be, at least partially, of fetal origin (5,6). Indeed, fetal umbilical vein inflammatory cytokine levels, but not maternal serum values, correlate with the presence and severity of the placental histologic inflammation and umbilical cord vasculitis (7).Funisitis is characterized by perivascular infiltrates of inflammatory cells and is considered one of the strongest hallmarks of microbial invasion of the amniotic cavity and fetal inflammatory syndrome (8,9). While there is some debate with regard to the origin of the amniotic fluid (AF) neutrophilic response to infection (10), there is consensus that the fetal inflammatory neutrophilic response originates initially from the umbilical vein and later from the arteries leading to umbilical cord vasculitis and funisitis (11). Funisitis is a well-recognized risk factor for early-onset sepsis in the premature neonate (12,13).We have previously shown that proteomic mapping of the AF reveals a profile, designated as the Mass Restricted (MR) score, that is highly cha...

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Section: Methodsmentioning

confidence: 99%

“…Robust scientific evidence has confirmed that when intraamniotic inflammation secondary to, or independent of infection is superimposed upon prematurity, the consequences for the neonate can prove devastating (3,4). This association can be explained by an inflammatory cytokine cascade that seems to be, at least partially, of fetal origin (5,6).…”

mentioning

confidence: 99%

Proteomic Biomarkers of Intra-amniotic Inflammation: Relationship with Funisitis and Early-onset Sepsis in the Premature Neonate

Buhimschi

Abdel-Razeq

et al. 2007

Pediatr Res

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“…126 The risk of neonatal mortality seems to be higher when there is evidence of fetal inflammation (funisitis and/or fetal vessel angiitis). 127 In a population-based study of full-term infants born in the United States during 2008, the prevalence of CCA was 9.7 per 1,000 live births, and the neonatal mortality rate was higher among exposed infants (OR 1.72, 95% CI 1.20-2.45). 7 In contrast, several studies on CCA or HCA in VLBW infants, after correcting for confounders, showed no effect on mortality 11,60 or, on the contrary, they showed a protective effect.…”

Section: Mortalitymentioning

confidence: 99%

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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“…86 Numerous recent studies have investigated the association between chorioamnionitis and NEC. [87][88][89][90][91] A recent systematic review by Been et al analyzed 33 studies examining the association between chorioamnionitis and NEC. 92 Three distinct groups were identified, ie, clinical chorioamnionitis, histological chorioamnionitis, and histological chorioamnionitis with fetal involvement.…”

Section: Chorioamnionitismentioning

confidence: 99%

Necrotizing enterocolitis: current perspectives

Yajamanyam

Rasiah²,

Ewer³

2014

RRN

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Necrotizing enterocolitis is the most common gastrointestinal emergency in neonates, particularly in those born very preterm. It is a leading cause of morbidity and mortality, especially in extremely low birth weight infants. Despite extensive research, the pathophysiology of necrotizing enterocolitis remains unclear and therapeutic options are limited. Multiple risk factors have been reported, but most are associated with prematurity and its complications. This makes management very challenging in vulnerable preterm infants. In this review, we focus on the risk factors and some of the current research in this area, particularly studies aimed at early detection and potential preventive measures for this potentially lethal condition.

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Chorioamnionitis with a fetal inflammatory response is associated with higher neonatal mortality, morbidity, and resource use than chorioamnionitis displaying a maternal inflammatory response only

Cited by 176 publications

References 19 publications

Proteomic Biomarkers of Intra-amniotic Inflammation: Relationship with Funisitis and Early-onset Sepsis in the Premature Neonate

Proteomic Biomarkers of Intra-amniotic Inflammation: Relationship with Funisitis and Early-onset Sepsis in the Premature Neonate

Chorioamnionitis and neonatal morbidity: current perspectives

Necrotizing enterocolitis: current perspectives

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