Severity of chorioamnionitis and neonatal outcome

Sato, Miho; Nishimaki, Shigeru; Yokota, Shumpei; Seki, Kazuhiko; Horiguchi, Haruko; An, Hiromi; Ishida, Fumihiko; Fujita, Shujiro; Ao, Kota; Yatake, Haruko

doi:10.1111/j.1447-0756.2010.01519.x

Cited by 45 publications

(38 citation statements)

References 20 publications

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“…When adjusting for gestational age, other studies have confirmed that chorioamnionitis is an independent risk factor for early-onset neonatal sepsis (108,109), bronchopulmonary dysplasia (95), adverse neurodevelopmental outcome at 3 years (110), and necrotizing enterocolitis (108). Interestingly, the severity of chorioamnionitis has been shown to correlate with an increased frequency of chronic lung disease and necrotizing enterocolitis (111) but has an inverse relationship with the development of respiratory distress syndrome (112).…”

Section: Neonatal Sequelae Of Chorioamnionitismentioning

confidence: 95%

The Human Ureaplasma Species as Causative Agents of Chorioamnionitis

et al. 2017

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SUMMARY The human Ureaplasma species are the most frequently isolated microorganisms from the amniotic fluid and placentae of women who deliver preterm and are also associated with spontaneous abortions or miscarriages, neonatal respiratory diseases, and chorioamnionitis. Despite the fact that these microorganisms have been habitually found within placentae of pregnancies with chorioamnionitis, the role of Ureaplasma species as a causative agent has not been satisfactorily explained. There is also controversy surrounding their role in disease, particularly as not all women infected with Ureaplasma spp. develop chorioamnionitis. In this review, we provide evidence that Ureaplasma spp. are associated with diseases of pregnancy and discuss recent findings which demonstrate that Ureaplasma spp. are associated with chorioamnionitis, regardless of gestational age at the time of delivery. Here, we also discuss the proposed major virulence factors of Ureaplasma spp., with a focus on the multiple-banded antigen (MBA), which may facilitate modulation/alteration of the host immune response and potentially explain why only subpopulations of infected women experience adverse pregnancy outcomes. The information presented within this review confirms that Ureaplasma spp. are not simply “innocent bystanders” in disease and highlights that these microorganisms are an often underestimated pathogen of pregnancy.

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Section: Neonatal Sequelae Of Chorioamnionitismentioning

confidence: 95%

The Human Ureaplasma Species as Causative Agents of Chorioamnionitis

et al. 2017

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“…In 19 of 27 studies, the patient characteristics were clearly differentiated between the CA and non-CA groups. In 15 out of these 19 studies, there was a significantly higher GA at birth among the non-CA group compared to the CA group [21,27,28,36,41,43,45,56,57,58,60,62,63,64,65]. Only 8 studies showed no difference among the groups in terms of GA [42,43,47,50,52,58,61,66].…”

Section: Methodsmentioning

confidence: 99%

“…The clinical profile of the infants and the methodological characteristics of the studies have been summarized in online supplementary appendix A (see www.karger.com/doi/10.1159/000357556 for all online suppl. material) [36,37,38,39,40,41,42,43,44,45,46,47,48,49,50,51,52,53,54,55,56,57,58,59,60,61,62,63,64,65,66,67,68,69]. …”

Section: Methodsmentioning

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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“…Recent reports have raised the possibility that fetal exposure to inflammation is a potent maturational signal only if not too severe, whereas severe inflammation will injure the fetal lung [9,10]. However, no human study has demonstrated this possibility, and there are only conflicting data about the frequency of RDS according to the stage or grade of acute-HCA [11,12]. Lee et al [11] demonstrated there is a stepwise but nonsignificant increase in RDS according to the stage or grade of acute-HCA or funisitis after adjusting for confounding variables including gestational age (GA) at delivery, while a significant inverse relationship was observed between the stage of acute-HCA and development of RDS after the adjustment for GA in the study by Sato et al [12].…”

Section: Introductionmentioning

confidence: 99%

Mild to Moderate, but Not Minimal or Severe, Acute Histologic Chorioamnionitis or Intra-Amniotic Inflammation Is Associated with a Decrease in Respiratory Distress Syndrome of Preterm Newborns without Fetal Growth Restriction

Park

Jun

et al. 2015

Neonatology

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Background: Acute histologic chorioamnionitis (acute-HCA) is known to be associated with a decreased risk of respiratory distress syndrome (RDS) in newborns. However, there is no information about whether the severity of acute-HCA or intra-amniotic inflammation (IAI) is associated with the development of RDS. Objectives: To assess the relationship between the severity of acute-HCA or IAI and the development of RDS in preterm newborns due to preterm labor and intact membranes (PTL) or preterm premature rupture of membranes (preterm-PROM) without fetal growth restriction (FGR). Methods: The frequency of RDS was examined in 378 singleton preterm neonates (24.5-34 weeks' gestation) due to PTL or preterm-PROM without FGR. Patients were divided into 4 groups according to the severity of acute-HCA (i.e. total grade: minimal, 1; mild, 2; moderate, 3-4; severe, 5-6) or IAI (i.e. amniotic fluid MMP-8: minimal, 23-100 ng/ml; mild, 100-400 ng/ml; moderate, 400-800 ng/ml; severe, ≥800 ng/ml). Amniotic fluid MMP-8 was measured in 196 patients delivered within 7 days of amniocentesis. Results: Mild to moderate, but not minimal or severe, acute-HCA (minimal, 24%; mild, 13%; moderate, 19%; severe, 41%; preterm-reference group, 26%) or IAI (minimal, 24%; mild, 11%; moderate, 17%; severe, 25%; preterm reference group, 23%) was associated with a significant decrease in RDS as compared with the preterm reference group (each for p < 0.05 after the adjustment of gestational age at delivery, antenatal corticosteroid use, newborn gender, cesarean delivery and preterm-PROM as a cause of preterm birth). Conclusions: Mild to moderate, but not minimal or severe, acute-HCA or IAI is associated with a significant decrease in RDS among preterm neonates due to PTL or preterm-PROM without FGR.

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Severity of chorioamnionitis and neonatal outcome

Cited by 45 publications

References 20 publications

The Human Ureaplasma Species as Causative Agents of Chorioamnionitis

The Human Ureaplasma Species as Causative Agents of Chorioamnionitis

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

Mild to Moderate, but Not Minimal or Severe, Acute Histologic Chorioamnionitis or Intra-Amniotic Inflammation Is Associated with a Decrease in Respiratory Distress Syndrome of Preterm Newborns without Fetal Growth Restriction

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