Clinical Dilemma of Positive Histologic Chorioamnionitis in Term Newborn

Alain, Cuna; Hakima, Laleh; Tseng, Yun An; Fornier, Bianca; Islam, Shahidul; Quintos-Alagheband, Maria Lyn; Khullar, Poonam; Weinberger, Barry; Hanna, Nazeeh

doi:10.3389/fped.2014.00027

Cited by 25 publications

(47 citation statements)

References 31 publications

(30 reference statements)

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“…These findings are consistent with previous reports [164, 259]. Cuna et al reported that the presence of acute histologic chorioamnionitis did not improve the predictive performance of other biomarkers for the identification of early-onset neonatal sepsis [259].…”

Section: Discussionsupporting

confidence: 93%

Clinical chorioamnionitis at term VI: acute chorioamnionitis and funisitis according to the presence or absence of microorganisms and inflammation in the amniotic cavity

Romero¹,

Chaemsaithong²,

Docheva³

et al. 2015

Journal of Perinatal Medicine

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Objective Neonates born to mothers with clinical chorioamnionitis at term are at an increased risk of infection. Acute subchorionitis, chorioamnionitis, and funisitis are considered placental histologic features consistent with acute inflammation according to the Society for Pediatric Pathology. The objectives of this study were to examine the performance of placental histologic features in the identification of: 1) microbial-associated intra-amniotic inflammation (intra-amniotic infection); and 2) a fetal inflammatory response syndrome (FIRS). Methods and Materials This retrospective cohort study included women with the diagnosis of clinical chorioamnionitis at term (n=45), who underwent an amniocentesis to determine: 1) the presence of microorganisms using both cultivation and molecular biologic techniques [polymerase chain reaction (PCR) with broad range primers]; and 2) interleukin (IL)-6 concentrations by enzyme-linked immunosorbent assay (ELISA). The diagnostic performance (sensitivity, specificity, accuracy, and likelihood ratios) of placental histologic features consistent with acute inflammation was determined for the identification of microbial-associated intra-amniotic inflammation and FIRS. Results 1) The presence of acute histologic chorioamnionitis and funisitis was associated with the presence of proven intra-amniotic infection assessed by amniotic fluid analysis; 2) funisitis was also associated with the presence of FIRS; 3) the negative predictive value of acute funisitis ≥ stage 2 for the identification of neonates born to mothers with intra-amniotic infection was less than 50%, and therefore, suboptimal to exclude fetal exposure to bacteria in the amniotic cavity; and 4) acute funisitis ≥ stage 2 had a negative predictive value of 86.8% for the identification of FIRS in a population with a prevalence of 20%. Conclusion Acute histologic chorioamnionitis and funisitis are associated with intra-amniotic infection and the presence of FIRS. However, current pathologic methods have limitations in the identification of the fetus exposed to microorganisms present in the amniotic cavity. Further studies are required to determine whether molecular markers can enhance the performance of placental pathology in the identification of neonates at risk for neonatal sepsis.

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Section: Discussionsupporting

confidence: 93%

Clinical chorioamnionitis at term VI: acute chorioamnionitis and funisitis according to the presence or absence of microorganisms and inflammation in the amniotic cavity

Romero¹,

Chaemsaithong²,

Docheva³

et al. 2015

Journal of Perinatal Medicine

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“…This study shows that the prevalence of chorioamnionitis in the study population was high and similar in the two groups of patients (57.1%and 61.6%of HIV-positive and HIV-negative subjects, respectively). This finding is higher than 11.4% and 11.5% reported by Torricelli et al 18 and Cuna et al 19 but similar to the findings of Curtin et al 20 (57.3%). However, these studies were done in term pregnancies unlike this current study that included preterm pregnancies.…”

Section: Discussionsupporting

confidence: 83%

“…The association of intrapartum intravaginal examination and grading/staging of HCA confirms previous reports. 19 …”

Section: Discussionmentioning

confidence: 99%

Chorioamnionitis in pregnancy: a comparative study of HIV-positive and HIV-negative parturients

et al. 2015

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Background Chorioamnionitis is an important risk factor for vertical transmission of HIV/AIDS. We compared the prevalence and correlates of chorioamnionitis in HIV-positive and HIV-negative pregnant women. Methods HIV-positive and -negative parturients were interviewed, examined and had their placenta examined histologically for chorioamnionitis. Data regarding HIV were also retrieved from their hospital records. Results A total of 298 parturients (150 HIV positive and 148 HIV negative) were enrolled. The two groups were similar in socio-demographic and obstetric parameters except for age. The prevalence of HCA was 57.1% in HIV-positive women and 61.6% in HIV-negative women (p = 0.43). HCA staging was associated with the number of intrapartum vaginal examinations in HIV-positive subjects and nulliparity in HIV-negative subjects. The number of intrapartum vaginal examinations and coitus in the week prior to delivery significantly affected the grade of HCA in HIV-negative subjects. Conclusion The prevalence of HCA in both HIV-positive and HIV-negative is high. Most variables did not affect the occurrence of histologic chorioamnionitis in both groups studied except number of intrapartum examinations, coitus in the preceding one week and nulliparity which were related to severity of the disease.

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“…Some cord blood biomarker levels are associated with placental inflammation representing a neonatal response to a perinatal insult [26, 27]. Although the role of placental histopathology in the diagnosis of neonatal sepsis and treatment decisions remains unclear [28], placental inflammation may be a useful tool to identify infants exposed to intraamniotic infection.…”

Section: Introductionmentioning

confidence: 99%

Cord Blood Acute Phase Reactants Predict Early Onset Neonatal Sepsis in Preterm Infants

et al. 2017

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BackgroundEarly onset sepsis (EOS) is a major cause of morbidity and mortality in preterm infants, yet diagnosis remains inadequate resulting in missed cases or prolonged empiric antibiotics with adverse consequences. Evaluation of acute phase reactant (APR) biomarkers in umbilical cord blood at birth may improve EOS detection in preterm infants with intrauterine infection.MethodsIn this nested case-control study, infants (29.7 weeks gestation, IQR: 27.7–32.2) were identified from a longitudinal cohort with archived cord blood and placental histopathology. Patients were categorized using culture, laboratory, clinical, and antibiotic treatment data into sepsis groups: confirmed sepsis (cEOS, n = 12); presumed sepsis (PS, n = 30); and no sepsis (controls, n = 30). Nine APRs were measured in duplicate from cord blood using commercially available multiplex immunoassays (Bio-Plex Pro™). In addition, placental histopathologic data were linked to biomarker results.ResultscEOS organisms were Escherichia coli, Streptococcus agalactiae, Proteus mirabilis, Haemophilus influenzae and Listeria monocytogenes. C-reactive protein (CRP), serum amyloid A (SAA), haptoglobin (Hp), serum amyloid P and ferritin were significantly elevated in cEOS compared to controls (p<0.01). SAA, CRP, and Hp were elevated in cEOS but not in PS (p<0.01) and had AUCs of 99%, 96%, and 95% respectively in predicting cEOS. Regression analysis revealed robust associations of SAA, CRP, and Hp with EOS after adjustment for covariates. Procalcitonin, fibrinogen, α-2-macroglobulin and tissue plasminogen activator were not significantly different across groups. Placental acute inflammation was associated with APR elevation and was present in all cEOS, 9 PS, and 17 control infants.ConclusionThis study shows that certain APRs are elevated in cord blood of premature infants with EOS of intrauterine origin. SAA, CRP, and Hp at birth have potential diagnostic utility for risk stratification and identification of infants with EOS.

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Clinical Dilemma of Positive Histologic Chorioamnionitis in Term Newborn

Cited by 25 publications

References 31 publications

Clinical chorioamnionitis at term VI: acute chorioamnionitis and funisitis according to the presence or absence of microorganisms and inflammation in the amniotic cavity

Clinical chorioamnionitis at term VI: acute chorioamnionitis and funisitis according to the presence or absence of microorganisms and inflammation in the amniotic cavity

Chorioamnionitis in pregnancy: a comparative study of HIV-positive and HIV-negative parturients

Cord Blood Acute Phase Reactants Predict Early Onset Neonatal Sepsis in Preterm Infants

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