Histologic chorioamnionitis in preterm infants: correlation with brain magnetic resonance imaging at term equivalent age

Abstract

BackgroundTo explore the associations between histologic chorioamnionitis with brain injury, maturation and size on magnetic resonance imaging (MRI) of preterm infants at term equivalent age.MethodsPreterm infants (23–36 weeks’ gestational age) were recruited into two longitudinal cohort studies. Presence or absence of chorioamnionitis was obtained from placental histology and clinical data were recorded. MRI at term-equivalent age was assessed for brain injury (intraventricular haemorrhage, cysts, signal abnormalities), maturation (degree of myelination, gyral maturation) and size of cerebral structures (metrics and brain segmentation). Histologic chorioamnionitis was assessed as a predictor of MRI variables using linear and logistic regression, with adjustment for confounding perinatal variables.ResultsTwo hundred and twelve infants were included in this study, 47 (22%) of whom had histologic chorioamnionitis. Histologic chorioamnionitis was associated with higher odds of intraventricular haemorrhage (odds ratio [OR] (95% confidence interval [CI]) = 7.4 (2.4, 23.1)), less mature gyral maturation (OR (95% CI) = 2.0 (1.0, 3.8)) and larger brain volume (mean difference in cubic centimeter (95% CI) of 14.1 (1.9, 26.2)); but all relationships disappeared following adjustment for perinatal variables.ConclusionHistologic chorioamnionitis was not independently associated with IVH, less mature gyral maturation or brain volume at term-equivalent age in preterm infants.Electronic supplementary materialThe online version of this article (10.1186/s12887-018-1001-6) contains supplementary material, which is available to authorized users.

Antenatal infection and intraventricular hemorrhage in preterm infants

“…Fifteen studies were excluded as there was no relevant comparison and 1 study was excluded as it was a review. Ultimately, we pooled data from 23 studies involving 13,605 preterm infants [18,23,29–49] for the meta-analysis (Fig. 1).…”

“…[22] Recently, clinical studies have reported a relationship between antenatal infection and IVH. [18,23] To date, there has been no systematic review regarding the relationship between antenatal infection and IVH. Thus, we systematically reviewed the current evidence evaluating the effects of antenatal infection on the risk of IVH in preterm infants.…”

Placental Pathology Findings and the Risk of Intraventricular and Cerebellar Hemorrhage in Preterm Neonates

“…A study in 2012 failed to find any association (37), whereas the meta-analysis of Villamor-Martinez et al (13) showed that both clinical and histological chorioamnionitis constitute an independent risk factor for GMH-IVH. In 2018, Granger et al demonstrated the same association, although after adjustment for perinatal variables, this association disappeared (38). In the same year, a multicenter study on 350 preterm infants found no association between histological chorioamnionitis and GMH-IVH diagnosed with early postnatal brain MRI (39).…”

Postnatal Paraclinical Parameters Associated to Occurrence of Intracerebral Hemorrhage in Preterm Infants

“…24 Also, the effect of chorioamnionitis on ICH is not straightforward. 25 While some findings indicated no association 26 between chorioamnionitis and intraventricular hemorrhage, others recognized chorioamnionitis as a risk factor of intraventricular hemorrhage. 27,28 Preeclampsia was associated with decreased risk for ICH.…”

“…6.18). Higher CRP values before ICH were positively associated with the risk of ICH.There was no significant difference in the leukocyte count between the affected and control groups neither before nor after ICH (no ICH: 15.99 AE 13.88 Â 10 9 /L; before ICH: 15.61 AE 11.68 Â 10 9 /L, p-value ¼ 0.79, OR ¼ 1 25,. 95% CI ¼ 0.85-1.86; after ICH: 26.43 AE 24.25 Â 10 9 /L, p-value ¼ 0.08, OR ¼ 2.41, 95% CI ¼ 1.66-3.49).…”