Effect of Chorioamnionitis on Early Childhood Asthma

Getahun, Darios; Strickland, Daniel; Zeiger, Robert S.; Fassett, Michael J.; Chen, Wansu; Rhoads, George G.; Jacobsen, Steven J.

doi:10.1001/archpediatrics.2009.238

Cited by 92 publications

(87 citation statements)

References 54 publications

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“…[16][17][18][19][20][21][22] Mechanistically, it has been proposed that chorioamnionitis, because of the associated proinflammatory state and heightened immune response, might play a role in asthma development for infants born preterm. 20,29 The few studies of late prematurity and the development of asthma showed mixed results. Using survey data from a nationally representative sample, Abe et al 24 did not find an association with late-preterm birth when asthma was assessed on the basis of caregiver reports.…”

Section: Discussionmentioning

confidence: 99%

“…By using ICD-9 codes from the chronic problem lists and visit histories, we measured any diagnosis of asthma (code 493.X) within the 18-month period as a binary outcome. 25,29 We also measured the diagnosis of persistent asthma as a binary out-come, including mild, moderate, and severe persistent asthma. These classifications, which were developed by the Children's Hospital of Philadelphia in 2001 on the basis of ICD-9 codes to help physicians designate the severity of asthma, were determined through physician judgment on the basis of National Asthma Education and Prevention Program guidelines.…”

Section: Outcome Variablesmentioning

confidence: 99%

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Association of Late-Preterm Birth With Asthma in Young Children: Practice-Based Study

2011

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OBJECTIVE: To evaluate the association of late-preterm birth with asthma severity among young children. METHODS: A retrospective cohort study was performed with electronic health record data from 31 practices affiliated with an academic medical center. Participants included children born in 2007 at 34 to 42 weeks of gestation and monitored from birth to 18 months. We used multivariate logistic or Poisson models to assess the impact of late-preterm (34–36 weeks) and low-normal (37–38 weeks) compared with term (39–42 weeks) gestation on diagnoses of asthma and persistent asthma, inhaled corticosteroid use, and numbers of acute respiratory visits. RESULTS: Our population included 7925 infants (7% late-preterm and 21% low-normal gestation). Overall, 8.3% had been diagnosed with asthma by 18 months. Compared with term gestation, late-preterm gestation was associated with significant increases in persistent asthma diagnoses (adjusted odds ratio [aOR]: 1.68), inhaled corticosteroid use (aOR: 1.66), and numbers of acute respiratory visits (incidence rate ratio: 1.44). Low-normal gestation was associated with increases in asthma diagnoses (aOR: 1.34) and inhaled corticosteroid use (aOR: 1.39). CONCLUSION: Birth at late-preterm and low-normal gestational ages might be an important risk factor for the development of asthma and for increased health service use in early childhood.

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Section: Discussionmentioning

confidence: 99%

Section: Outcome Variablesmentioning

confidence: 99%

Association of Late-Preterm Birth With Asthma in Young Children: Practice-Based Study

2011

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“…Thus, chorioamnionitis is a common fetal exposure that may in part explain the adverse respiratory outcomes of prematurity. Indeed, both prospective and retrospective studies found an independent association of chorioamnionitis in premature infants with subsequent wheezing (13,14). In animal models, chorioamnionitis can disrupt alveolar and pulmonary vascular development and modulate fetal/neonatal immune responses (15).…”

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confidence: 99%

Pulmonary Morbidity in Infancy after Exposure to Chorioamnionitis in Late Preterm Infants

et al. 2016

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Rationale: Chorioamnionitis is an important cause of preterm birth, but its impact on postnatal outcomes is understudied.Objectives: To evaluate whether fetal exposure to inflammation is associated with adverse pulmonary outcomes at 6 to 12 months' chronological age in infants born moderate to late preterm. Methods:Infants born between 32 and 36 weeks' gestational age were prospectively recruited (N = 184). Chorioamnionitis was diagnosed by placenta and umbilical cord histology. Select cytokines were measured in samples of cord blood. Validated pulmonary questionnaires were administered (n = 184), and infant pulmonary function testing was performed (n = 69) between 6 and 12 months' chronological age by the raised volume rapid thoracoabdominal compression technique. Measurements and Main Results:A total of 25% of participants had chorioamnionitis. Although infant pulmonary function testing variables were lower in infants born preterm compared with historical normative data for term infants, there were no differences between infants with chorioamnionitis (n = 20) and those without (n = 49). Boys and black infants had lower infant pulmonary function testing measurements than girls and white infants, respectively. Chorioamnionitis exposure was associated independently with wheeze (odds ratio [OR], 2.08) and respiratory-related physician visits (OR, 3.18) in the first year of life. Infants exposed to severe chorioamnionitis had increased levels of cord blood IL-6 and greater pulmonary morbidity at age 6 to 12 months than those exposed to mild chorioamnionitis. Elevated IL-6 was associated with significantly more respiratory problems (OR, 3.23).Conclusions: In infants born moderate or late preterm, elevated cord blood IL-6 and exposure to histologically identified chorioamnionitis was associated with respiratory morbidity during infancy without significant changes in infant pulmonary function testing measurements. Black compared with white and boy compared with girl infants had lower infant pulmonary function testing measurements and worse pulmonary outcomes.

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“…Mast cells in the lower airways contribute to the development of asthma and allergic diseases (26). Mast cells are of interest because of a possible relation between chorioamnionitis, preterm birth, and the development of asthma later in life (27,28). Mast cell activation results in degranulation, leading to the rapid release of inflammatory mediators, such as histamine, proteoglycans, and cytokines, which stimulate the recruitment of other inflammatory cells (29).…”

Section: Effects Of Lps As Gestation Advancesmentioning

confidence: 99%

Effects of intra-amniotic lipopolysaccharide exposure on the fetal lamb lung as gestation advances

et al. 2014

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Background: Intra-amniotic lipopolysaccharide (LPS) exposure may affect neonatal outcome by altering fetal lung and immune system development. We hypothesized that intra-amniotic LPS exposure would cause persistent fetal pulmonary responses as the lungs develop in utero. Methods: Fetal lambs were exposed to intra-amniotic LPS at 118 or at 118 and 123 d of gestational age (GA) with delivery at 125, 133, or 140 d (term = 147 d). Immune responses, PU.1 expression, toll-like receptor (tLR)-1,2,4,6 mRNA levels, mast cell levels, and pulmonary elastin deposition were evaluated. results: After a single dose of LPS, pulmonary inflammatory responses were observed with increases of (i) PU.1 and tLR1 at 125 d GA and (ii) monocytes, lymphocytes, tLR2, and tLR6 at 133 d GA. Repetitive LPS exposure resulted in (i) increases of neutrophils, monocytes, PU.1, and tLR1 at 125 d GA; (ii) increases of neutrophils, PU.1, and tLR2 at 133 d GA; and (iii) decreases of mast cells, elastin foci, tLR4, and tLR6 at early gestation. At 140 d GA, only PU.1 was increased after repetitive LPS exposure. conclusion: The preterm fetal lung can respond to a single exposure or repeated exposures from intra-amniotic LPS in multiple ways, but the absence of inflammatory and structural changes in LPS-exposed fetuses delivered near term suggest that the fetus can resolve an inflammatory stimulus in utero with time.

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Effect of Chorioamnionitis on Early Childhood Asthma

Cited by 92 publications

References 54 publications

Association of Late-Preterm Birth With Asthma in Young Children: Practice-Based Study

Association of Late-Preterm Birth With Asthma in Young Children: Practice-Based Study

Pulmonary Morbidity in Infancy after Exposure to Chorioamnionitis in Late Preterm Infants

Effects of intra-amniotic lipopolysaccharide exposure on the fetal lamb lung as gestation advances

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