Histological chorioamnionitis is predicted by early infant C‐reactive protein in preterm infants and correlates with neonatal outcomes

Ryan, Emer; Eves, Doireann; Menon, Poornima Jayadev; Alnafisee, Sarah; Mooney, Eoghan E.; Downey, Paul; Culliton, M.; Murphy, John F.; Vavasseur, Claudine; Molloy, Eleanor J.

doi:10.1111/apa.15038

Cited by 18 publications

(25 citation statements)

References 33 publications

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“…CAM prediction studies using neonatal inflammatory markers have been reported using a combination of either CRP levels and WBC count, or CRP levels and immature-to-total neutrophil ratio. 9,10 Consistent with these studies, a combination of neonatal inflammatory markers showed better sensitivity for fully developed histological CAM and funisitis than single markers. Moreover, cut-off values for four neonatal inflammatory markers were determined in two different periods (on admission and 12-36 h postnatally), and significant inflammatory markers and period combinations were chosen by multivariate analysis.…”

Section: Ta B L E 3 Prediction Scores For Mir ≥2 and Fir ≥2supporting

confidence: 62%

“…Furthermore, serum CRP level, procalcitonin (PCT) level and neutrophil count in cord blood were significantly higher in preterm neonates with histologically confirmed CAM 8 . To predict CAM in preterm neonates with gestational age (GA) of ≤32 weeks, several studies have used inflammatory markers such as serum CRP levels and white blood cell (WBC) and neutrophil counts in the cord or neonatal blood 9–12 . However, no previous study has predicted CAM and funisitis using PCT from a cord and neonatal blood.…”

Section: Introductionmentioning

confidence: 99%

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Prediction scores based on neonatal inflammatory markers for chorioamnionitis and funisitis in extremely low gestational age neonates

et al. 2023

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Aim:The aim of the study was to examine the predictive value of inflammatory markers for chorioamnionitis and funisitis in extremely low gestational age neonates. Methods:According to the Redline histopathological classification, extremely low gestational age neonates were classified into: (1) maternal inflammatory response ≤1 or ≥2, based on inflammatory findings of the placenta and (2) foetal inflammatory response ≤1 or ≥2, based on inflammatory findings of the umbilical cord. On admission and 12-36 h postnatally, procalcitonin and high-sensitivity C-reactive protein levels and white blood cell and neutrophil counts were compared. For both maternal and foetal inflammatory responses ≥2, the predictive value of each inflammatory marker was calculated.Results: On admission, procalcitonin had the best predictive value for maternal and foetal inflammatory response ≥2. The maternal inflammatory response ≥2 prediction score includes procalcitonin level on admission, high-sensitivity C-reactive protein level and white blood cell count at 12-36 h postnatally. Foetal inflammatory response ≥2 prediction score includes procalcitonin level and white blood cell count on admission and 12-36 h postnatally. The sensitivities were 96.4% and 96.3%, respectively. Conclusion:Procalcitonin, high-sensitivity C-reactive protein levels and white blood cell count provide highly sensitive prediction scores for chorioamnionitis and funisitis in extremely low gestational age neonates.

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Section: Ta B L E 3 Prediction Scores For Mir ≥2 and Fir ≥2supporting

confidence: 62%

Section: Introductionmentioning

confidence: 99%

Prediction scores based on neonatal inflammatory markers for chorioamnionitis and funisitis in extremely low gestational age neonates

et al. 2023

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“…Our results suggest that a maternal WBC ≥ 16.75 × 10* 9 /L is not only indicative of chorioamnionitis but also increases the possibility of neonatal EOS. Using objective clinical data available at birth, Ryan et al (2019) found that maternal CRP >10 mg/L was associated with a fetal inflammatory response and increased risk of EOS. Puopolo et al designed a predictive model for EOS for infants born at ≥ 34 weeks gestation, they found that the two most important predictors were gestational age and maternal fever ( American College of Obstetricians and Gynecologists’ Task Force on Neonatal Encephalopathy, 2014 ).…”

Section: Discussionmentioning

confidence: 99%

A retrospective study of risk factors for early-onset neonatal sepsis with intrapartum maternal fever

Zheng

Zhu

et al. 2022

PeerJ

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Background Intrapartum fever is a well-known risk factor for adverse perinatal outcomes. In this study, we evaluated the clinical features for intrapartum maternal fever and investigated the risk factors for neonatal early-onset sepsis (EOS) with intrapartum maternal fever. Methods This retrospective cohort study involved a total of 568 neonates born to mothers with intrapartum maternal fever (temperature peak ≥38 degree Celsius) in Hangzhou Women’s Hospital from January 1st to December 31st, 2019. Neonates were assigned to the EOS and non-sepsis groups based on the diagnostic criteria for early-onset neonatal sepsis,. Demographic data, clinical information and laboratory test results were evaluated to assess the risk factors for EOS. Results A total of 568 neonates were included in this study, 84 of whom were diagnosed with EOS. The EOS group was significantly different from the non-sepsis group in 11 items including the both white blood cell (WBC) count and C-reactive protein (CRP) level of the mother before delivery (p < 0.05). A logistic regression analysis revealed that a high maternal WBC count before delivery (OR = 3.261, p = 0.019) and a maternal histological chorioamnionitis (HCA) diagnosis (OR = 5.608, p = 0.002) were independent risk factors for EOS. The optimal cut-off value for WBC (before delivery) was 16.75 × 10*9/L for EOS, according to receiver operating characteristic analysis (area under curve was 0.821). Conclusions Elevated prenatal maternal WBC counts and maternal HCA diagnosis are both independently associated with EOS. Prenatal maternal WBC counts can be used as a sensitive indicator to predict EOS early.

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“…The possibility of fetal in ammatory response syndrome (FIRS) may accompany subclinical stage chorioamnionitis diagnosis, , since the fetus develops a response to infection in early stages. There is a common link between fetal in ammatory response and poor fetal outcomes (7)(8)(9). Funisitis and chorionic vasculitis are FIRS hallmarks, wherein interleukin-6 concentrations rise in fetal plasma; this then leads to preterm labor, higher rates of neonatal morbidity (after adjustment for gestational age) and multi-organ fetal involvement (1).…”

Section: Introductionmentioning

confidence: 99%

Frozen section in amniotic infection, an underutilized diagnostic tool?

Ladino

Caicedo-Marmolejo

Vargas

et al. 2022

Preprint

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Introduction: Chorioamnionitis and funisitis produce high impact maternal, fetal and neonatal repercussions; intra-amniotic infections are present in 40-70% of preterm deliveries; additionally, intrauterine infections trigger systemic inflammatory conditions in 50% of exposed fetuses. On the contrary, maternal symptoms register low sensitivity for diagnosis of intrauterine infections. Herein, we discuss the need for a new diagnostic tool that will allow for early capture of subclinical cases. Methods: Between 2020 and 2022, we included 30 patients born with (Group 1:15) or without (Group 2:15) suspected intra-amniotic infection . We compared frozen sections to final paraffin sections, we correlated conventional process to neonate clinical outcome, taking into account changes in treatment based on early diagnosis of the infection. Results: Group 1 presented the largest number of cases for preterm delivery, low birth weight, complications and total hospital stay. Furthermore, in Group 1, we found 33.3% early sepsis diagnosis, as opposed to 6.67% in Group 2; following positive pathology report, both duration of antibiotic management and length of clinical observation: it was extended over a greater length of time than expected as standard. Discussion: Research has validated the premise on which we based our study, a clear relation between chorioamnionitis and fetal death and preterm delivery, the outcome of which also results in an increase in comorbidities. Early diagnosis of infection, especially of funisitis, is clinically useful for subsequent intervention. Conclusions: The use of frozen biopsy in ascending subclinical infection can aid in reaching early chorioamniontis/funisitis diagnosis, thereby providing guidance in medical interventions. This technique has proven its performance in predicting definitive infection outcomes. However, there is still a need for further studies on how to profile patients with subclinical infections who would benefit from frozen biopsy analysis.

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Histological chorioamnionitis is predicted by early infant C‐reactive protein in preterm infants and correlates with neonatal outcomes

Cited by 18 publications

References 33 publications

Prediction scores based on neonatal inflammatory markers for chorioamnionitis and funisitis in extremely low gestational age neonates

Prediction scores based on neonatal inflammatory markers for chorioamnionitis and funisitis in extremely low gestational age neonates

A retrospective study of risk factors for early-onset neonatal sepsis with intrapartum maternal fever

Frozen section in amniotic infection, an underutilized diagnostic tool?

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