Early neonatal brain injury in histologic chorioamnionitis

Felice, Claudio De; Toti, Paolo; Laurini, Ricardo; Stumpo, Michela; Picciolini, Enrico; Todros, Tullia; Tanganelli, Piero; Buonocore, Giuseppe; Bracci, Rodolfo

doi:10.1067/mpd.2001.109605

Cited by 147 publications

(79 citation statements)

References 18 publications

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“…12 An association between infection and CP has been reported in preterm or low birth weight infants in several studies. [13][14][15][16][17] Several investigators have reported estimates of two-to four-fold increases in risk of CP associated with chorioamnionitis or maternal infection in preterm or very low birth weight infants, but not all reached statistical significance. 16,18 -21 For preterm infants, Wu and Colford 7 reported a summary relative risk of 1.9 (95% CI 1.4 to 2.5) for clinical chorioamnionitis and 1.6 (95% CI 0.9 to 2.7) for histologic chorioamnionitis in her meta-analysis.…”

Section: Discussionmentioning

confidence: 99%

Maternal Infection and Risk of Cerebral Palsy in Term and Preterm Infants

et al. 2004

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We tested the hypothesis that term and preterm infants exposed to maternal infection at the time of delivery are at increased risk of developing cerebral palsy (CP). STUDY DESIGN:A population-based case-control study was conducted using Washington State birth certificate data linked to hospital discharge data. Cases (688) were children r6 years old, singleton births, hospitalized during 1987 to 1999 with an ICD-9 diagnosis code for CP. Controls were 3068 singleton birth infants randomly selected from birth records for the same years without CP-related hospitalizations. Infection information was available only for the birth hospitalization. RESULTS:Infants of women who had any infection during their hospitalization for delivery were at increased risk of CP (odds ratio (OR) 3.1, 95% confidence interval (CI) 2.3 to 4.2). This was observed for term deliveries (OR 1.8, 95% CI 1.1 to 2.8) and preterm deliveries (OR 2.3, 95% CI 1.3 to 4.2). CONCLUSIONS:Our results suggest that maternal infection is a risk factor for CP in both term and preterm infants.

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Section: Discussionmentioning

confidence: 99%

Maternal Infection and Risk of Cerebral Palsy in Term and Preterm Infants

et al. 2004

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“…Preterm infants who are exposed to chorioamnionitis have a 2-to 4-fold increased risk of IVH (18,(47)(48)(49)(50) and a 6-fold increased risk for PVL (51,52). WMD occurs in 65% of preterm infants who are born to mothers with culture-positive amniotic fluid or histologic chorioamnionitis compared with 9% of infants who are born to mothers without evidence of intrauterine infection (9).…”

Section: Discussionmentioning

confidence: 99%

Inflammatory Markers in Intrauterine and Fetal Blood and Cerebrospinal Fluid Compartments Are Associated with Adverse Pulmonary and Neurologic Outcomes in Preterm Infants

et al. 2004

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“…Recent epidemiologic and clinical investigations indicate that premature infants who are exposed to chorioamnionitis are at increased risk for developing IVH (1), PVL (1,2), and cerebral palsy (2)(3)(4). The etiology of the white matter injury in chorioamnionitis-exposed infants remains uncertain but likely involves some component of ischemic (5)(6)(7)(8) and/or inflammatory (9,10) damage to the developing oligodendroglia.…”

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Variability in Cerebral Oxygen Delivery Is Reduced in Premature Neonates Exposed to Chorioamnionitis

et al. 2006

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Premature infants exposed to chorioamnionitis are at increased risk for periventricular leukomalacia (PVL) and intraventricular hemorrhage (IVH), lesions that may result from inflammation and/or fluctuations in cerebral blood flow. The effect of chorioamnionitis on near-infrared spectroscopy (NIRS) measures of cerebral oxygen delivery has not been evaluated previously. Forty-nine infants born at 25-31 6/7 wk gestation underwent NIRS examination on d 1, 2, 3, and 7 of life. Variability in NIRS tracings was analyzed by partitioning each tracing into three components: long-term, intermediate, and short-term variability; the latter two components were analyzed. Chorioamnionitis-exposed infants manifest reduced intermediate variability in cerebral oxygenated and deoxygenated Hb but not total Hb. Infants with severe IVH/PVL had the lowest intermediate variability on d 1. Short-term variability was similar between chorioamnionitis-exposed and unexposed infants, and between infants with versus without severe IVH or PVL. We conclude that intermediate-term variability in NIRS cerebral oxygen delivery is reduced in chorioamnionitis-exposed infants. We speculate that intermediate variability represents the important time frame for evaluating the pathogenesis of perinatal brain injury. Further studies are needed to determine how these findings relate to cerebral blood flow autoregulation and oxygen utilization in premature infants. C horioamnionitis is perhaps the most common cause of premature delivery. Recent epidemiologic and clinical investigations indicate that premature infants who are exposed to chorioamnionitis are at increased risk for developing IVH (1), PVL (1,2), and cerebral palsy (2-4). The etiology of the white matter injury in chorioamnionitis-exposed infants remains uncertain but likely involves some component of ischemic (5-8) and/or inflammatory (9,10) damage to the developing oligodendroglia. It has been demonstrated that preterm infants who develop IVH have fluctuations in Doppler-derived cerebral blood flow velocities (11). With the application of NIRS, it became evident that infants with both IVH and PVL have fluctuations in cerebral oxygen delivery (12) that correlate with fluctuations in blood pressure and indicate impaired cerebral autoregulatory ability (11). The relationship between variability in NIRS measures of cerebral oxygen delivery and exposure to chorioamnionitis has not been evaluated previously.The overall objective of this investigation was to determine the variability among NIRS measures of cerebral oxygen delivery in premature infants exposed and unexposed to chorioamnionitis. We first devised a method that would allow us to assess both intermediate and short-term variability in NIRS measures of cerebral oxygenated, deoxygenated, and total Hb. Next, we tested the hypothesis that variability decreases with increasing gestational and postnatal age, as the risk of IVH and PVL abate. Finally, we compared variability in NIRS measures of cerebral oxygen delivery between infants ex...

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Early neonatal brain injury in histologic chorioamnionitis

Cited by 147 publications

References 18 publications

Maternal Infection and Risk of Cerebral Palsy in Term and Preterm Infants

Maternal Infection and Risk of Cerebral Palsy in Term and Preterm Infants

Inflammatory Markers in Intrauterine and Fetal Blood and Cerebrospinal Fluid Compartments Are Associated with Adverse Pulmonary and Neurologic Outcomes in Preterm Infants

Variability in Cerebral Oxygen Delivery Is Reduced in Premature Neonates Exposed to Chorioamnionitis

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