A Clinical Prediction Rule for Histological Chorioamnionitis in Preterm Newborns

Abstract

BackgroundHistological chorioamnionitis (HC) is an intrauterine inflammatory process highly associated with preterm birth and adverse neonatal outcome. HC is often clinically silent and diagnosed postnatally by placental histology. Earlier identification could facilitate treatment individualisation to improve outcome in preterm newborns.AimDevelop a clinical prediction rule at birth for HC and HC with fetal involvement (HCF) in preterm newborns.MethodsClinical data and placental pathology were obtained from singleton preterm newborns (gestational age ≤32.0 weeks) born at Erasmus UMC Rotterdam from 2001 to 2003 (derivation cohort; n = 216) or Máxima MC Veldhoven from 2009 to 2010 (validation cohort; n = 206). HC and HCF prediction rules were developed with preference for high sensitivity using clinical variables available at birth.ResultsHC and HCF were present in 39% and 24% in the derivation cohort and in 44% and 22% in the validation cohort, respectively. HC was predicted with 87% accuracy, yielding an area under ROC curve of 0.95 (95%CI = 0.92–0.98), a positive predictive value of 80% (95%CI = 74–84%), and a negative predictive value of 93% (95%CI = 88–96%). Corresponding figures for HCF were: accuracy 83%, area under ROC curve 0.92 (95%CI = 0.88–0.96), positive predictive value 59% (95%CI = 52–62%), and negative predictive value 97% (95%CI = 93–99%). External validation expectedly resulted in some loss of test performance, preferentially affecting positive predictive rather than negative predictive values.ConclusionUsing a clinical prediction rule composed of clinical variables available at birth, HC and HCF could be predicted with good test characteristics in preterm newborns. Further studies should evaluate the clinical value of these rules to guide early treatment individualisation.

Histological chorioamnionitis is predicted by early infant C‐reactive protein in preterm infants and correlates with neonatal outcomes

“…24 In our cohort, maternal clinical signs were not a good discriminator; only 9.4% of mothers with proven HCA age. 25 The prediction of HCA with CRP can enhance this tool further and is stronger when combined with a raised ratio of immature to total neutrophils >0.2. When the immature bands are raised and the CRP > 1 mg/L, the PPV for HCA was 92%, and the NPV was 85%;…”

Outcomes of Very-Low-Birth-Weight Infants Exposed to Maternal Clinical Chorioamnionitis: A Multicentre Study

“…In addition, clinical diagnosis is faster and easier and could be useful in guiding clinical decision-making from a practical perspective. Recently, Been et al [30] developed a clinical prediction rule based on clinical variables available at birth to predict histological chorioamnionitis and histological chorioamnionitis with fetal involvement in singleton preterm newborns ≤32 weeks' GA. Although not applicable to multiplets, more mature newborns, or when the diagnostic criteria for histological chorioamnionitis used are different, these rules showed good positive and negative predictive values.…”

A Multicenter Lung Ultrasound Study on Transient Tachypnea of the Neonate

“…TTN was clinically defined as the presence of tachypnea (respiratory rate > 60/min) and dyspnea (Silverman score > 1) appearing within the first 24 h of life, needing only oxygen supplementation and/or nasal continuous airway pressure (CPAP). Exclusion criteria were: (1) major malformations or chromosomal abnormalities; (2) early-onset sepsis or pneumonia (defined by the presence of clinical, radiological, and microbiological criteria as detailed elsewhere [8]) and increased inflammatory markers as per local NICU protocols, or the diagnosis of clinical chorioamnionitis (defined elsewhere [9]); (3) lack of parental consent; (4) a diagnosis of neonatal acute respiratory distress syndrome according to the Montreux definition [10]; (5) a diagnosis of classical hyaline membrane disease, i.e., respiratory distress syndrome (RDS) (as previously described [10]). Basically, RDS was defined as the presence of typical chest X-rays (a diffuse ground-glass appearance) and the need for surfactant replacement.…”