Lung and Brain Damage in Preterm Newborns

Dammann, Olaf; Leviton, Alan; Bartels, Dorothee B.; Dammann, Christiane E.L.

doi:10.1159/000078175

Cited by 51 publications

(33 citation statements)

References 71 publications

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“…Perinatal inflammation has been associated with a number of adverse neurological outcomes in preterm infants such as white matter injury, intraventricular hemorrhage, cystic periventricular leukomalacia and cerebral palsy [23,70,71,72]. Maternal intrauterine infection and inflammation can induce a production of proinflammatory cytokines in the fetal brain such as tumor necrosis factor-α (TNF-α) and interleukins (IL)-1, IL-6, and IL-8.…”

Section: Discussionmentioning

confidence: 99%

“…These findings suggest that perinatal inflammation and infection may have a deleterious effect on the developing blood vessels in the retina, making them vulnerable to the development of ROP. In a number of recently published studies, histological CA has in fact been shown to be an important risk factor for the development of early-onset sepsis as well as subsequent neonatal disorders of the lung, intestines and brain including white matter injuries and intraventricular hemorrhage [17,18,19,20,21,22,23,24,25]. …”

Section: Introductionmentioning

confidence: 99%

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Chorioamnionitis as a Risk Factor for Retinopathy of Prematurity: A Systematic Review and Meta-Analysis

Mitra

Aune²,

Speer³

et al. 2014

Neonatology

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Background: The role of chorioamnionitis (CA) in the development of retinopathy of prematurity (ROP) has not been well established. Objective: To conduct a systematic review and meta-analysis of the association between CA and ROP in preterm infants. Data Sources: The authors searched MEDLINE, Embase, CINAHL, Cochrane Central Register of Controlled Trials and PubMed, reviewed reference lists of relevant articles, abstracts and conference proceedings (Society for Pediatric Research, European Society for Paediatric Research 1990-2012), sought results of unpublished trials, and contacted the primary authors of relevant studies. Study Selection: Studies were included if they had a comparison group, examined preterm infants, and reported primary data that could be used to measure the association between exposure to CA and the development of ROP. Data Extraction: Two reviewers independently screened the search results, applied inclusion criteria and assessed methodological quality using the Newcastle-Ottawa Scale. One reviewer extracted data and a second reviewer checked data extraction. Summary relative risks (RRs) were calculated using a random effects model. Data Synthesis: We identified 1,249 potentially relevant studies from the electronic databases. Twenty-seven studies involving 10,590 preterm neonates with 2,562 cases of ROP were included. Taking into account all included studies without adjusting for gestational age (GA), CA was significantly associated with ROP (any stage) [summary RR 1.33 (95% CI 1.14-1.55, I² = 77%, p_{heterogeneity} < 0.0001)], and a borderline significant association was observed for severe ROP (stage ≥3) [summary RR 1.27 (95% CI 0.99-1.63, I² = 74%, p_{heterogeneity} < 0.0001)]. There was no publication bias with Begg's test. However, subgroup analysis of studies adjusting for GA showed no significant association on CA with ROP [summary RR 0.98 (95% CI 0.77-1.26, I² = 0%, p_{heterogeneity} = 0.89)]. Conclusion: Unadjusted analyses showed that CA was significantly associated with ROP (any stage) as well as with severe ROP (stage ≥ 3). However, the association disappeared on analysis of studies adjusting for GA. Hence, CA cannot be definitively considered as a risk factor for ROP, and further studies should adjust for potential confounding factors and report results by stage to clarify the association with severe ROP.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Chorioamnionitis as a Risk Factor for Retinopathy of Prematurity: A Systematic Review and Meta-Analysis

Mitra

Aune²,

Speer³

et al. 2014

Neonatology

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“…6 Preeclampsia, as a pathophysiologic condition, is now known to be associated with fewer adverse neurologic outcomes in newborns than other obstetric complications, such as the fetal inflammatory response syndrome, so often seen in preterm premature rupture of the membranes. 8 In one recent study conducted outside the United States among preeclamptic mothers, virtually none of whom had received MgSO 4 prophylaxis, no child was later found to have cystic periventricular leukomalacia (cPVL), an important risk factor for subsequent CP. 9 Thus, despite the absence of magnesium exposure, there appears to be some, as yet to be characterized, biological factor in the pathogenesis of maternal preeclampsia that is inherently neuroprotective for babies.…”

Section: Initial Magnesium and Cp Hypothesismentioning

confidence: 99%

Brain lesions in newborns exposed to high-dose magnesium sulfate during preterm labor

Mittendorf

Dammann

2005

J Perinatol

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High-dosage, tocolytic magnesium sulfate (MgSO 4 ) administered to pregnant women during preterm labor can be toxic, and sometimes lethal, for their newborns (Cochrane Database of Systematic Reviews (relative mortality risk 2.82, 95% confidence interval 1.2-6.6)). Based on the results of the Magnesium and Neurologic Endpoints Trial and the work of many others, a unifying triangular concept is proposed to account for the increased prevalence of brain lesions, with their likely resultant mortality, in neonates and infants exposed to high-dose MgSO 4 in the context of preterm labor. We review the evidence that: (1) elevated circulating levels of serum ionized magnesium occurring in mothers, and therefore in their babies, at the time of delivery are associated with subsequent neonatal intraventricular hemorrhage (IVH); (2) neonatal IVH is strongly associated with lenticulostriate vasculopathy (LSV), an unusual mineralizing lesion involving the thalami and basal ganglia of the neonate; and, (3) exposure to 50 g or more of tocolytic MgSO 4 during preterm labor is associated with the development of LSV.

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“…1 The term chorioamnionitis refers to both the clinical syndrome of intrauterine infection and the histological process responsible for it. Most important, chorioamnionitis is often clinically silent.…”

Section: Introductionmentioning

confidence: 99%

Preterm premature rupture of membranes, chorioamnion inflammatory scores and neonatal respiratory outcome

Zanardo¹,

Vedovato²,

Cosmi

et al. 2009

BJOG

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Objective To evaluate whether histological chorioamnionitis (HCA), in the setting of preterm premature rupture of membranes (PPROM), affects infant respiratory outcome.Design A prospective histological study on 287 consecutive placentas was performed in preterm infants (£32 +6 weeks gestation), categorised into four groups: according to the presence or absence of HCA, in the setting or in absence of PPROM. Results Among the 287 NICU admitted preterm infants, 68/287 (23.6%) presented with HCA, 16/68 (23.5%) with a coexisting fetal inflammatory response, and 74/287 (25.7%) with PPROM. HCA was associated with a greater frequency of vaginal delivery (P < 0.0001), lower gestational age (P < 0.0001) and lower birth weight (P < 0.01). HCA had no effect on fetal lung maturation, however, it was a significant risk factor for CLD (RR; 95% CI 2.08; 1.30-3.33). HCA and the fetal inflammatory response were also significant risk factors for PPROM (RR; 95% CI 2.07; 1.42-3.03 and 2.64; 1.71-4.09 respectively). Conversely, HCA in the setting of PPROM failed to reveal any RDS protection or subtype CLD risk. Multivariate analysis demonstrated significant independent effects of presence of maternal HCA (P = 0.04), gestational age (P < 0.0001) and interaction HCA-gestational age (P = 0.04) on CLD development, regardless of the presence of fetal HCA or fetal HCA-gestational age interaction, PPROM or PPROM-gestational age interaction.Conclusions Histological chorioamnionitis is a significant PPROM and CLD risk factor, but it fails to provide any protection from RDS. HCA in the setting of PPROM also failed to reveal any RDS protection or subtype CLD risk.Keywords Chronic lung disease, fetal inflammatory response syndrome, histological chorioamnionitis, preterm premature rupture of membranes, respiratory distress syndrome.Please cite this paper as: Zanardo V, Vedovato S, Cosmi E, Litta P, Cavallin F, Trevisanuto D, Chiarelli S. Preterm premature rupture of membranes, chorioamnion inflammatory scores and neonatal respiratory outcome. BJOG 2010;117:94-98.

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Lung and Brain Damage in Preterm Newborns

Cited by 51 publications

References 71 publications

Chorioamnionitis as a Risk Factor for Retinopathy of Prematurity: A Systematic Review and Meta-Analysis

Chorioamnionitis as a Risk Factor for Retinopathy of Prematurity: A Systematic Review and Meta-Analysis

Brain lesions in newborns exposed to high-dose magnesium sulfate during preterm labor

Preterm premature rupture of membranes, chorioamnion inflammatory scores and neonatal respiratory outcome

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