The importance of intra-amniotic inflammation in the subsequent development of atypical chronic lung disease

Lee, Joonho; Oh, Kyung Joon; Yang, Hye Jin; Park, Joong Shin; Romero, Roberto; Yoon, Bo Hyun

doi:10.1080/14767050902994705

Cited by 46 publications

(39 citation statements)

References 54 publications

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“…Intra-amniotic inflammation has been implicated in the development of so-called atypical CLD (ie, CLD not preceded by respiratory distress syndrome) 29. All infants in our Low FiO 2 group and many infants in our PD group would have been classified as having atypical CLD using this definition.…”

Section: Discussionmentioning

confidence: 99%

Antecedents of chronic lung disease following three patterns of early respiratory disease in preterm infants

Laughon

Bose

Allred

et al. 2010

Archives of Disease in Childhood - Fetal and Neonatal Edition

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OBJECTIVES/INTRODUCTION The incidence of chronic lung disease (CLD) varies among groups defined by their early pattern of respiratory disease. Although CLD is common among infants with continuous exposure to increased ambient oxygen throughout the first two postnatal weeks the antecedents of CLD among preterm infants without this exposure are not well understood. PATIENTS AND METHODS We examined data collected prospectively on the 1204 (out of 1506) infants born in 2002 to 2004 at 23 to 27 completed weeks of gestation who survived to 36 weeks post-menstrual age (PMA). Based on their initial respiratory presentation and need for supplemental oxygen during the first two weeks, infants were classified as having early and persistent pulmonary dysfunction (EPPD), early recovery of pulmonary function followed by deterioration (PD), or consistently good pulmonary function characterized by low FiO2 (Low FiO2). RESULTS CLD was diagnosed in 69% of infants with EPPD, in 52% with PD, and 17% in the Low FiO2 group. Risk factors for CLD varied among these groups. Birth weight z-score < -1 conveyed information about CLD risk in all three groups and was the major risk factor for infants in the Low FiO2 group (Odds Ratio [OR] 27; 95% confidence interval [CI] 7–95). Mechanical ventilation at 7 days was associated with increased risk in the pulmonary deterioration group (OR 4.2, 95% CI 2.5–6.9) and the early and persistent pulmonary dysfunction group (OR 2.7, 95% CI 1.5–4.7), but not the Low FiO2 group (OR 1.5, 95% CI 0.5–3.9). CONCLUSION Both the likelihood of a very preterm infant developing CLD and the profile of risk factors linked with CLD are related to the infant’s pattern of respiratory disease during the first two postnatal weeks. Among infants with little exposure to oxygen during this period, fetal growth restriction, not mechanical ventilation, is the factor with the strongest association with CLD.

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Section: Discussionmentioning

confidence: 99%

Antecedents of chronic lung disease following three patterns of early respiratory disease in preterm infants

Laughon

Bose

Allred

et al. 2010

Archives of Disease in Childhood - Fetal and Neonatal Edition

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“…The concentrations of these cytokines in normal amniotic fluid at birth are on the order of nanograms per millilitre, and therefore higher than that in the synovial fluid of patients with septic arthritis or in the cerebrospinal fluid of patients with bacterial meningitis [34]. In very low birth weight infants (and especially in those with sepsis), perinatal inflammation has been associated with the onset of chronic lung disease [35]. In apparent contrast, chorioamnionitis was found to protect against chronic lung disease in a sample of 798 children born preterm, especially in those with no signs of sepsis [36].…”

Section: Early-life Origins Of Chronic Respiratory Diseases | S Carrmentioning

confidence: 99%

Early-life origins of chronic respiratory diseases: understanding and promoting healthy ageing

et al. 2014

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Chronic obstructive respiratory disorders such as asthma and chronic obstructive pulmonary disease often originate early in life. In addition to a genetic predisposition, prenatal and early-life environmental exposures have a persistent impact on respiratory health. Acting during a critical phase of lung development, these factors may change lung structure and metabolism, and may induce maladaptive responses to harmful agents, which will affect the whole lifespan.Some environmental factors, such as exposure to cigarette smoke, type of childbirth and diet, may be modifiable, but it is more difficult to influence other factors, such as preterm birth and early exposure to viruses or allergens.Here, we bring together recent literature to analyse the critical aspects involved in the early stages of lung development, going back to prenatal and perinatal events, and we discuss the mechanisms by which noxious factors encountered early on may have a lifelong impact on respiratory health.We briefly comment on the need for early disease biomarkers and on the possible role of ''-omic'' technologies in identifying risk profiles predictive of chronic respiratory conditions. Such profiles could guide the ideation of effective preventive strategies and/or targeted early lifestyle or therapeutic interventions. @ERSpublications Early-life factors have a role in onset of asthma and COPD; early postnatal interventions may promote lung health http://ow.ly/BvUrx

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“…These data suggested that fetal aspiration of cytokines contributes to a local pulmonary inflammation which makes the lung more susceptible for further injury from barotrauma or oxygen toxicity. In a retrospective study, amniotic fluid concentrations of matrix metalloproteinase-8 and intraamniotic white blood cell counts were higher in infants born with a gestational age ^ 32 weeks who developed BPD without RDS compared to infants with BPD after RDS [53] . These data imply that intraamniotic inflammation is differentially associated with patterns of respiratory disease in these patients [53] .…”

Section: Chorioamnionitis and Respiratory Outcomementioning

confidence: 99%

“…In a retrospective study, amniotic fluid concentrations of matrix metalloproteinase-8 and intraamniotic white blood cell counts were higher in infants born with a gestational age ^ 32 weeks who developed BPD without RDS compared to infants with BPD after RDS [53] . These data imply that intraamniotic inflammation is differentially associated with patterns of respiratory disease in these patients [53] . An increased influx of neutrophils, a higher expression of proinflammatory cytokines and an increased apoptosis of airway epithelial cells has been demonstrated in lung tissues of stillborn fetuses exposed to chorioamnionitis [54,55] .…”

Section: Chorioamnionitis and Respiratory Outcomementioning

confidence: 99%

Chorioamnionitis: Important Risk Factor or Innocent Bystander for Neonatal Outcome?

2010

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Chorioamnionitis as a major risk factor for spontaneous preterm birth, especially at earlier gestational ages, contributes to prematurity-associated mortality and morbidity. A gestation-independent effect of chorioamnionitis on neonatal outcome is much more difficult to assess. The influence of chorioamnionitis on neonatal outcome has become less evident with advances in neonatal care. A short-term beneficial effect of histological, but not clinical chorioamnionitis on incidence and severity of respiratory distress syndrome in preterm infants is evident. This maturational effect is accompanied by a susceptibility of the lung for further postnatal injury, which predisposes for bronchopulmonary dysplasia. Chorioamnionitis is associated with cystic periventricular leukomalacia, intraventricular hemorrhage and cerebral palsy in preterm infants, but its association with noncystic white matter disease is not clear yet. Prenatal inflammation/infection has been shown a risk factor for neonatal sepsis. A single course of antenatal steroids can be regarded safe in clinical as well as histological chorioamnionitis.

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The importance of intra-amniotic inflammation in the subsequent development of atypical chronic lung disease

Abstract: Intra-amniotic inflammation confers a greater risk for atypical CLD than for typical CLD with initial RDS. This novel observation strengthens the importance of prenatal inflammation as a mechanism of lung injury.

Cited by 46 publications

References 54 publications

Antecedents of chronic lung disease following three patterns of early respiratory disease in preterm infants

Antecedents of chronic lung disease following three patterns of early respiratory disease in preterm infants

Early-life origins of chronic respiratory diseases: understanding and promoting healthy ageing

Chorioamnionitis: Important Risk Factor or Innocent Bystander for Neonatal Outcome?

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