Early- and Late-Respiratory Outcome in Very Low Birth Weight with or without Intrauterine Inflammation

Perniciaro, S.; Casarin, Jvan; Nosetti, Luana; Binda, Chiara; Salvatore, Silvia; Ghezzi, Fabio; Agosti, Massimo

doi:10.1055/s-0040-1714257

Cited by 9 publications

(6 citation statements)

References 36 publications

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“…Our measurements confirm and extend observations in previous studies reporting qualitative assessments of respiratory function in infants from mothers with chorioamnionitis 13–15. While they had no RFM data, these studies observed less spontaneous breathing and a greater need for both oxygen supplementation and invasive ventilation in the delivery room for infants affected by chorioamnionitis 13–15. These findings are consistent with the lower breathing effort and oxygenation observed in our study.…”

Section: Discussionsupporting

confidence: 92%

“…As CCA infants took significantly longer to reach an SpO 2 >80% and their SpO 2 was lower at 5 min after birth, despite receiving higher FiO 2 levels, we found that chorioamnionitis also adversely affected oxygenation, which is in line with previous studies 13 14. This is likely caused by reduced breathing effort, which delays lung aeration and reduces the surface area available for gas exchange.…”

Section: Discussionsupporting

confidence: 90%

“…The most prevalent form of inflammation affecting premature infants is chorioamnionitis, defined as antenatal inflammation of the fetal membranes and umbilical vessels 12. Infants affected by chorioamnionitis require more respiratory support at birth, which might be associated with the aforementioned inflammatory-mediated respiratory depression 13–16…”

Section: Introductionmentioning

confidence: 99%

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Effect of clinical chorioamnionitis on breathing effort in premature infants at birth: a retrospective case–control study

Panneflek

Kuypers

Polglase

et al. 2022

Arch Dis Child Fetal Neonatal Ed

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RationaleAntenatal inflammation, usually associated with chorioamnionitis, is a major cause of premature birth. As inflammation could depress respiratory drive, we have examined the effect of clinical chorioamnionitis (CCA) on spontaneous breathing in premature infants at birth.MethodsInfants with CCA born <30 weeks’ gestation were matched with control infants based on gestational age (±6 days), birth weight (±300 g), antenatal corticosteroids, sex and general anaesthesia. The primary outcome was breathing effort, assessed as minute volume (MV) of spontaneous breathing. We also measured tidal volume (Vt), respiratory rate (RR) and apnoea in the first 5 min and additional physiological parameters in the first 10 min after start of respiratory support.ResultsNinety-two infants were included (n=46 CCA infants vs n=46 controls; median (IQR) gestational age 26+4(25+0–27+6) vs 26+6(25+1–28+3) weeks). MV and Vt were significantly lower (MV: 43 (17–93) vs 70 (31–119) mL/kg/min, p=0.043; Vt: 2.6 (1.9–3.6) vs 2.9 (2.2–4.8) mL/kg/breath, p=0.046), whereas RR was similar in CCA infants compared with controls. Incidence of apnoea was higher (5 (2-6) vs 2 (1-4), p=0.002), and total duration of apnoea was longer (90 (21-139) vs 35 (12-98) s, p=0.025) in CCA infants. CCA infants took significantly longer to reach an oxygen saturation >80% (3:37 (2:10–4:29) vs 2:25 (1:06–3:52) min, p=0.016) and had a lower oxygen saturation at 5 min (77 (66–92) vs 91 (68–94) %, p=0.028), despite receiving more oxygen (62 (48-76) vs 54 (43-73) %, p=0.036).ConclusionCCA is associated with reduced breathing effort and oxygenation in premature infants at birth.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionsupporting

confidence: 90%

Section: Introductionmentioning

confidence: 99%

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Effect of clinical chorioamnionitis on breathing effort in premature infants at birth: a retrospective case–control study

Panneflek

Kuypers

Polglase

et al. 2022

Arch Dis Child Fetal Neonatal Ed

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“…Previous studies indicated that HCA or amniotic cavity infection and neonatal EOS were closely connected [ 6 , 7 ]. Moreover, Apgar score, endotracheal intubation rate, mechanical ventilation rate, pulmonary surfactant application, severe PDA rate, and the incidence of BPD in very low birth weight infants were related to HCA [ 18 ]. Maternal amnionitis led to the low gestational age and low birth weight of preterm infants, and it was an independent risk factor for intraventricular hemorrhage [ 19 ].…”

Section: Discussionmentioning

confidence: 99%

Risk factors and postnatal biomarkers for acute placental inflammatory lesions and intrauterine infections in preterm infants

Liu

et al. 2022

Eur J Pediatr

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The purpose of this study is to explore risk factors of acute placental inflammatory lesions and the potential postnatal serum biomarkers for predicting the severity of intrauterine infection in preterm infants. We performed a retrospective analysis of premature infants with or without acute placental inflammatory lesions and their mothers by chart review for clinical data and placental histopathology. The preterm infants with acute placental inflammatory lesions had a higher rate of premature rupture of membranes (PROM), a longer duration of PROM, and a higher level of serum sialic acid (SIA) than those of the non-inflammation group (all p < 0.001). According to the different inflammatory histological structures, preterm infants with funisitis had a dominant longer duration of PROM than others (p < 0.05), and their gestational age was youngest among all the infants (p < 0.05). Furthermore, they had the highest content of serum SIA above other groups. The preterm infants in the acute histological chorioamnionitis group showed a similar trend of clinical manifestation and laboratory parameters with the funisitis group. Moreover, the closer the placental lesions were to the fetus, the lower the gestational age of preterm infants was, and the higher the serum SIA content was.Conclusion: We utilized a simple and precise anatomically category method of placental inflammatory histopathology for pediatricians to distinguish the extent of fetal inflammatory response for representing early-onset infectious diseases of preterm infants. SIA might be one of the potential early-stage serum biomarkers to reflect the severe intrauterine infections and could guide the postnatal anti-infection treatment. What is Known:• Acute placental inflammatory lesion contributes to preterm birth and a series of complications in preterm infants.• C-reactive protein and interleukin-6 in neonatal blood can be used as biomarkers for potential early-onset sepsis, but they are influenced by the postnatal physiological changes of preterm infants. What is New:• The value of serum sialic acids of preterm infants within 1-hour afterbirth may be one of the rapid postnatal biomarkers for evaluating the severity of intra-amniotic infection.• The closer the placental lesions are to the fetus, the higher the content of serum sialic acid is.

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“…A large proportion of premature infants are antenatally exposed to inflammation of the foetal membranes and umbilical vessels, which fall under the umbrella term 'chorioamnionitis' [5]. Since chorioamnionitis-induced inflammation appears to depress breathing both before and after birth, premature infants affected by chorioamnionitis likely face the combined problems of an immature respiratory system and inflammatory-mediated respiratory depression, which synergistically could suppress effective continuous breathing of neonates at birth [6][7][8][9].…”

Section: Introductionmentioning

confidence: 99%

The influence of chorioamnionitis on respiratory drive and spontaneous breathing of premature infants at birth: a narrative review

Panneflek,

Kuypers,

Polglase

et al. 2024

Eur J Pediatr

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Most very premature infants breathe at birth but require respiratory support in order to stimulate and support their breathing. A significant proportion of premature infants are affected by chorioamnionitis, defined as an umbrella term for antenatal inflammation of the foetal membranes and umbilical vessels. Chorioamnionitis produces inflammatory mediators that potentially depress the respiratory drive generated in the brainstem. Such respiratory depression could maintain itself by delaying lung aeration, hampering respiratory support at birth and putting infants at risk of hypoxic injury. This inflammatory-mediated respiratory depression may contribute to an association between chorioamnionitis and increased requirement of neonatal resuscitation in premature infants at birth. This narrative review summarises mechanisms on how respiratory drive and spontaneous breathing could be influenced by chorioamnionitis and provides possible interventions to stimulate spontaneous breathing. Conclusion: Chorioamnionitis could possibly depress respiratory drive and spontaneous breathing in premature infants at birth. Interventions to stimulate spontaneous breathing could therefore be valuable. What is Known:• A large proportion of premature infants are affected by chorioamnionitis, antenatal inflammation of the foetal membranes and umbilical vessels. What is New:• Premature infants affected by chorioamnionitis might be exposed to higher concentrations of respiratory drive inhibitors which could depress breathing at birth.• Premature infants affected by chorioamnionitis seem to be associated with a higher and more extensive requirement of resuscitation at birth.

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Early- and Late-Respiratory Outcome in Very Low Birth Weight with or without Intrauterine Inflammation

Cited by 9 publications

References 36 publications

Effect of clinical chorioamnionitis on breathing effort in premature infants at birth: a retrospective case–control study

Effect of clinical chorioamnionitis on breathing effort in premature infants at birth: a retrospective case–control study

Risk factors and postnatal biomarkers for acute placental inflammatory lesions and intrauterine infections in preterm infants

The influence of chorioamnionitis on respiratory drive and spontaneous breathing of premature infants at birth: a narrative review

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