Intrauterine exposure to chorioamnionitis and neuroanatomical alterations at term-equivalent age in preterm infants

Nosaka, Rena; Ushida, Takafumi; Kidokoro, Hiroyuki; Kawaguchi, Masahiro; Shiraki, Anna; Iitani, Yukako; Imai, Kenji; Nakamura, Noriyuki; Sato, Yoshiaki; Hayakawa, Masahiro; Natsume, Jun; Kajiyama, Hiroaki; Kotani, Tomomi

doi:10.1007/s00404-023-07064-y

Cited by 5 publications

(2 citation statements)

References 51 publications

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“…The involved proteins disrupt the normal maturation of the central nervous system as well as the development of white matter and the effect is particularly aggravated in early preterm fetuses [ 37 – 40 ]. In the clinical setting, novel evidence suggests that intrauterine exposure to chorioamnionitis may provoke significant neuroanatomical alterations in the white matter, pallidum, and nucleus accumbens that can disrupt the physiology of the central nervous system [ 41 ]. These in turn result in cognitive dysfunction as white matter and the limbic system regulate behavior, motivation, long-term memory, as well as the ability to process novel information [ 42 ].…”

Section: Discussionmentioning

confidence: 99%

“…In this line, novel evidence focusing on neurogenic inflammation which is frequently associated with infection, toxin exposure, or traumatic brain injury [ 41 ] suggests that the process results in magnesium depletion which in turn triggers a cascade that results in secondary brain injury. Experimental studies involving rats have shown that Mg2+ deficient specimens have significantly larger cortical loss compared to animals with normal magnesium levels [ 44 ].…”

Section: Discussionmentioning

confidence: 99%

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Maternal and neonatal outcomes following magnesium sulfate in the setting of chorioamnionitis: a meta-analysis

Pergialiotis,

Sapantzoglou,

Rodolaki

et al. 2023

Arch Gynecol Obstet

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Purpose Magnesium sulfate (MgSO4) has been widely used in obstetrics as a mean to help decrease maternal and neonatal morbidity in various antenatal pathology. As a factor, it seems to regulate immunity and can, thus, predispose to infectious morbidity. To date, it remains unknown if its administration can increase the risk of chorioamnionitis. In the present meta-analysis, we sought to accumulate the available evidence. Methods We systematically searched Medline, Scopus, Clinicaltrials.gov, EMBASE, Cochrane Central Register of Controlled Trials CENTRAL, and Google Scholar databases in our primary search along with the reference lists of electronically retrieved full-text papers. Results Eight studies were included that investigated the incidence of chorioamnionitis among parturient that received MgSO4 and control patients. Magnesium sulfate was administered in 3229 women and 3330 women served as controls as they did not receive MgSO4. The meta-analysis of data revealed that there was no association between the administration of magnesium sulfate and the incidence of chorioamnionitis (OR 0.98, 95% CI 0.73, 1.32). Rucker’s analysis revealed that small studies did not significantly influence the statistical significance of this finding (OR 1.12, 95% CI 0.82, 1.53). Trial sequential analysis revealed that the required number to safely interpret the primary outcome was not reached. Two studies evaluated the impact of MgSO4 in neonates delivered in the setting of chorioamnionitis. Neither of these indicated the presence of a beneficial effect in neonatal morbidity, including the risk of cerebral palsy, intraventricular hemorrhage, necrotizing enterocolitis, bronchopulmonary dysplasia, sepsis, stillbirth, or neonatal death. Conclusion Current evidence indicates that magnesium sulfate is not associated with an increased risk of maternal chorioamnionitis. However, it should be noted that its effect on neonatal outcomes of offspring born in the setting of chorioamnionitis might be subtle if any, although the available evidence is very limited.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Maternal and neonatal outcomes following magnesium sulfate in the setting of chorioamnionitis: a meta-analysis

Pergialiotis,

Sapantzoglou,

Rodolaki

et al. 2023

Arch Gynecol Obstet

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Maternal and perinatal infectious morbidity in term prelabor rupture of membrane according to two induction of labor protocols

Abu Shqara,

Rosso,

Lowensetin

et al. 2024

Arch Gynecol Obstet

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Effect of chorioamnionitis on postnatal growth in very preterm infants: a population-based study in Japan

Ushida,

Nosaka,

Nakatochi

et al. 2024

Arch Gynecol Obstet

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Purpose There is growing evidence that preterm infants born to mothers with chorioamnionitis (CAM) have increased risk of various neonatal morbidities and long-term neurological disorders; however, the effect of CAM on postnatal growth remains insufficiently investigated. This study evaluated the effect of histological CAM on postnatal growth trajectories in very preterm infants using a nationwide neonatal database in Japan. Method A multicenter retrospective study was conducted using clinical data of 4220 preterm neonates who weighed ≤ 1500 g and were born at < 32 weeks of gestation between 2003–2017 (CAM group: n = 2110; non-CAM group: n = 2110). Z-scores for height and weight were evaluated at birth and 3 years of age. Univariable and multivariable analyses were conducted to evaluate the effect of histological CAM on ΔZ-scores of height and weight during the first three years with a stratification by infant sex and the stage of histological CAM. Results Multivariable analyses showed that histological CAM was associated with accelerated postnatal increase (ΔZ-score) in weight (β coefficient [95% confidence interval]; 0.10 [0.00 to 0.20]), but not in height among females (0.06 [− 0.04 to 0.15]) and not in height and weight among males (0.04 [− 0.04 to 0.12] and 0.02 [− 0.07 to 0.11], respectively). An interaction analysis demonstrated no significant difference in the effect of histological CAM on the ΔZ-scores of height and weight during the first three years between male and female infants (height, p = 0.81; weight p = 0.25). Conclusions Intrauterine exposure to maternal CAM contributes to accelerated postnatal weight gain in female preterm infants during the first three years.

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Intrauterine exposure to chorioamnionitis and neuroanatomical alterations at term-equivalent age in preterm infants

Cited by 5 publications

References 51 publications

Maternal and neonatal outcomes following magnesium sulfate in the setting of chorioamnionitis: a meta-analysis

Maternal and neonatal outcomes following magnesium sulfate in the setting of chorioamnionitis: a meta-analysis

Maternal and perinatal infectious morbidity in term prelabor rupture of membrane according to two induction of labor protocols

Effect of chorioamnionitis on postnatal growth in very preterm infants: a population-based study in Japan

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