A systemic fetal inflammatory response and the development of bronchopulmonary dysplasia

Yoon, Bo Hyun; Romero, Roberto; Kim, Kyung-Sun; Park, Joong Shin; Ki, Suk Hyun; Kim, Beyong Il; Jun, Jong Kwan

doi:10.1016/s0002-9378(99)70299-1

Cited by 345 publications

(218 citation statements)

References 25 publications

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“…13,14 Furthermore, several studies suggested that PPROM confers protection against RDS. [15][16][17][18] However, a large review did not confirm this protective effect. 19 In this scenario, the fetal lung significance of chorioamnion inflammation presence or absence in the setting of PPROM remains to be determined.…”

Section: Introductionmentioning

confidence: 97%

Preterm premature rupture of membranes, chorioamnion inflammatory scores and neonatal respiratory outcome

Zanardo¹,

Vedovato²,

Cosmi

et al. 2009

BJOG

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Objective To evaluate whether histological chorioamnionitis (HCA), in the setting of preterm premature rupture of membranes (PPROM), affects infant respiratory outcome.Design A prospective histological study on 287 consecutive placentas was performed in preterm infants (£32 +6 weeks gestation), categorised into four groups: according to the presence or absence of HCA, in the setting or in absence of PPROM. Results Among the 287 NICU admitted preterm infants, 68/287 (23.6%) presented with HCA, 16/68 (23.5%) with a coexisting fetal inflammatory response, and 74/287 (25.7%) with PPROM. HCA was associated with a greater frequency of vaginal delivery (P < 0.0001), lower gestational age (P < 0.0001) and lower birth weight (P < 0.01). HCA had no effect on fetal lung maturation, however, it was a significant risk factor for CLD (RR; 95% CI 2.08; 1.30-3.33). HCA and the fetal inflammatory response were also significant risk factors for PPROM (RR; 95% CI 2.07; 1.42-3.03 and 2.64; 1.71-4.09 respectively). Conversely, HCA in the setting of PPROM failed to reveal any RDS protection or subtype CLD risk. Multivariate analysis demonstrated significant independent effects of presence of maternal HCA (P = 0.04), gestational age (P < 0.0001) and interaction HCA-gestational age (P = 0.04) on CLD development, regardless of the presence of fetal HCA or fetal HCA-gestational age interaction, PPROM or PPROM-gestational age interaction.Conclusions Histological chorioamnionitis is a significant PPROM and CLD risk factor, but it fails to provide any protection from RDS. HCA in the setting of PPROM also failed to reveal any RDS protection or subtype CLD risk.Keywords Chronic lung disease, fetal inflammatory response syndrome, histological chorioamnionitis, preterm premature rupture of membranes, respiratory distress syndrome.Please cite this paper as: Zanardo V, Vedovato S, Cosmi E, Litta P, Cavallin F, Trevisanuto D, Chiarelli S. Preterm premature rupture of membranes, chorioamnion inflammatory scores and neonatal respiratory outcome. BJOG 2010;117:94-98.

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Section: Introductionmentioning

confidence: 97%

Preterm premature rupture of membranes, chorioamnion inflammatory scores and neonatal respiratory outcome

Zanardo¹,

Vedovato²,

Cosmi

et al. 2009

BJOG

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“…Infection occurs in 40-70% of premature deliveries. Recent evidence indicates that intrauterine infection is one of the main risk factors in newborn's inflammatory response syndrome, white matter lesions, cerebral palsy, chronic pulmonary illnesses and sepsis (5)(6)(7)(8)(9). Therefore accurate prediction of infection, including maternal chorioamnionitis and early-onset neonatal infection, remains a critical challenge for obstetrician management in these cases.…”

Section: Introductionmentioning

confidence: 99%

Preterm premature rupture of membranes at 32–34 weeks of gestation: duration of membrane rupture period and maternal blood indicators relation with congenital infection

Daunoravičienė¹,

Musteikytė²,

Ramašauskaitė³

2015

AML

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Background. The study investigates the influence of the length of membrane rupture period among pregnant women with preterm premature rupture of membranes (PPROM) between the 32nd and 34th weeks of gestation on the development of chorioamnionitis and the congenital infection of a newborn. It seeks to ascertain the values of indicators in mother's blood that enable to predict chorioamnionitis and funisitis for mothers, and congenital infection for newborns.Materials and methods. A retrospective study of case records of women with PPROM at 32 (32 w. + 0 d)-34 (33 w. + 6 d) weeks of gestation and their newborns was performed. Two comparative groups were made: 1) of women who had funisitis and / or chorioamnionitis with or without deciduitis and 2) of women having no proved inflammation (according to the results of histological examination of placentae). Analogically, comparative groups were made of their newborns: those who had diagnosis of congenital infection and those who had no infection. The duration of membrane rupture period and the blood markers were investigated in all the groups.Results. The study included 135 women. Duration of the membrane rupture period lasted 85.17 ± 84.72 hrs in the group of women who had histological inflammation, and 40.06 ± 56.57 hrs in the group with no inflammation, P = 0.01, AUC = 0.735; the critical membrane rupture period value for developing intrauterine infection by the Youden index was 43.7 hrs. The corresponding maternal CRP values (mg/l) were 25.85 ± 40.27 vs. 5.23 ± 7.88 (P = 0.01, AUC = 0.6), the Youden index 4.6 mg/l. For the mothers of the newborns diagnosed with infection, the duration of the membrane rupture period was 55.95 ± 65.04 hrs, for the mothers of the newborns without congenital infection it was 40.25 ± 73.71 hours. Respectively, CRP values for the mothers of newborns averaged 12.25 ± 22.14 mg/l vs. 4.8 ± 4.82 mg/l (P = 0.005).Conclusions. Longer membrane rupture period and higher maternal CRP are correlated with inflammatory changes in the placenta and umbilical cord, thus they can be used as the prognostic indicators of intrauterine infection. When the duration of the membrane rupture period lasts ≥44 hrs, the risk of chorioamnionitis and funisitis increases five times; when the maternal serum CRP is higher than 5 mg/l, funisitis / chorioamnionitis is twice more frequent than at lower than 5 mg/l CRP values.

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“…[4][5][6] In this study, we focused on urinary excretion of B2M obtained from premature infants at birth as an alternative inflammatory marker, because a routine measurement of these cytokines in such clinical specimens is not yet feasible.…”

Section: Discussionmentioning

confidence: 99%

“…[1][2][3][4] The term 'fetal inflammatory response syndrome' describes the strong association between elevated levels of proinflammatory cytokines in the umbilical cord plasma, as well as increased neonatal morbidity and mortality. 5 Bronchopulmonary dysplasia (BPD) is a representative example of the pathophysiology among premature infants born to mothers with chorioamnionitis (CAM).…”

Section: Introductionmentioning

confidence: 99%

“…Elevated inflammatory mediators such as interleukin-6, interleukin-8 and tumor necrosis factor-in the umbilical cord plasma or amniotic fluid have already been reported to be sensitive indicators of CAM and independent risk factors for the development of BPD. 4,6 However, a direct assay of proinflammatory cytokines, which is both expensive and time consuming, is not suitable for routine laboratory testing in neonatal intensive care practice.…”

Section: Introductionmentioning

confidence: 99%

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Urinary β-2-microglobulin as an alternative marker for fetal inflammatory response and development of bronchopulmonary dysplasia in premature infants

et al. 2010

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Objective: To evaluate the clinical utility of urinary b-2-microglobulin (B2M) at birth, an alternative to proinflammatory cytokines, as an indicative marker of fetal inflammatory response and subsequent higher risk of bronchopulmonary dysplasia (BPD) in premature infants.Study Design: The relationship between urinary B2M at birth and the occurrence of BPD was examined in 96 premature infants with a description of perinatal backgrounds. Constructing a receiver-operating characteristic curve to determine the cutoff value of urinary B2M at birth for the development of BPD, a multivariate logistic regression analysis was performed to evaluate whether elevated urinary B2M at birth can be used as a predictor of BPD.Results: BPD was diagnosed in 34% (33/96) of the infants. Neonates with BPD had a significantly higher occurrence rate of chorioamnionitis and greater levels of median urinary B2M at birth than did those without BPD. The selected cutoff value of urinary B2M at birth correlated with the development of BPD, even after adjusting for gestational age and other confounding factors.Conclusions: Elevated urinary B2M levels at birth can be used as an alternative marker of fetal inflammatory response and subsequent higher risk of BPD in premature infants.

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A systemic fetal inflammatory response and the development of bronchopulmonary dysplasia

Cited by 345 publications

References 25 publications

Preterm premature rupture of membranes, chorioamnion inflammatory scores and neonatal respiratory outcome

Preterm premature rupture of membranes, chorioamnion inflammatory scores and neonatal respiratory outcome

Preterm premature rupture of membranes at 32–34 weeks of gestation: duration of membrane rupture period and maternal blood indicators relation with congenital infection

Urinary β-2-microglobulin as an alternative marker for fetal inflammatory response and development of bronchopulmonary dysplasia in premature infants

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