American Journal of Obstetrics & Gynecology
Volume 201, Issue 6 , Pages 587.e1-587.e8, December 2009

Histologic chorioamnionitis, fetal involvement, and antenatal steroids: effects on neonatal outcome in preterm infants

Presented, in part, at the 35th Annual Meeting of the Fetal and Neonatal Physiologic Society, Maastricht, The Netherlands, June 22-25, 2008; the Annual Congress of the European Academy of Paediatrics, Barcelona, Spain, Oct. 7-10, 2006; and the Annual Meeting of the Pediatric Academic Societies, San Francisco, CA, April 29-May 2, 2006.

  • Jasper V. Been, MD

      Affiliations

    • Department of Pediatrics, School for Oncology and Developmental Biology (GROW), Maastricht University Medical Center, Maastricht, The Netherlands
    • ,
  • Ingrid G.I.J.G. Rours, MD

      Affiliations

    • Department of Pediatric Infectious Diseases and Immunology, Erasmus University Medical Center, Rotterdam, The Netherlands
    • Department Medical Microbiology and Infectious Diseases, Erasmus University Medical Center, Rotterdam, The Netherlands
    • Department of Pediatrics, Maasstad Hospital, Rotterdam, The Netherlands
    • ,
  • René F. Kornelisse, MD, PhD

      Affiliations

    • Department of Pediatrics, Division of Neonatology, Erasmus Medical Center–Sophia Children's Hospital, Rotterdam, The Netherlands
    • ,
  • Valéria Lima Passos, PhD

      Affiliations

    • Department of Methodology and Statistics, Maastricht University, Maastricht, The Netherlands
    • ,
  • Boris W. Kramer, MD, PhD

      Affiliations

    • Department of Pediatrics, School for Oncology and Developmental Biology (GROW), Maastricht University Medical Center, Maastricht, The Netherlands
    • ,
  • Tom A.J. Schneider, MD

      Affiliations

    • Department of Obstetrics and Prenatal Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands
    • ,
  • Ronald R. de Krijger, MD, PhD

      Affiliations

    • Department of Pathology, Erasmus University Medical Center, Rotterdam, The Netherlands
    • ,
  • Luc J.I. Zimmermann, MD, PhD

      Affiliations

    • Department of Pediatrics, School for Oncology and Developmental Biology (GROW), Maastricht University Medical Center, Maastricht, The Netherlands

Received 12 January 2009; received in revised form 3 April 2009; accepted 4 June 2009. published online 03 September 2009.

Objective

The objective of the study was to study the effects of histologic chorioamnionitis (HC) with or without fetal involvement and antenatal steroid (AS) exposure on neonatal outcome in a prospective cohort of preterm infants.

Study Design

The clinical characteristics and placental histology were prospectively collected in 301 infants born at a gestational age 32.0 weeks or less in the Erasmus University Medical Center.

Results

In univariable analyses, HC without fetal involvement (n = 53) was associated with decreased severe respiratory distress syndrome (RDS) (11% vs 28%; P < .05), whereas HC with fetal involvement infants (n = 68) had more necrotizing enterocolitis (9% vs 2%; P < .05), intraventricular hemorrhage (IVH) (25% vs 12%; P < .05), and neonatal mortality (19% vs 9%; P < .05). In HC without fetal involvement infants, AS reduced the incidences of RDS (43% vs 85%; P < .05) and IVH (5% vs 39%; P < .01). In multivariable analyses, HC without fetal involvement was associated with decreased severe RDS (odds ratio, 0.22; 95% confidence interval, 0.05–0.93; P < .05) and increased early-onset sepsis (odds ratio, 2.22; 95% confidence interval, 1.02–4.83; P < .05).

Conclusion

In a prospective cohort of preterm infants, multivariable analyses reveal only a modest association between histologic chorioamnionitis and neonatal outcome.

Key words: antenatal steroids, chorioamnionitis, fetal inflammation, neonatal outcome, preterm infants

 

 Reprints not available from the authors.

 This study was supported in part by the Revolving Fund, Erasmus University Medical Center, Rotterdam, The Netherlands. J.V.B. is supported by a Profileringsfonds Grant from the Maastricht University Medical Center.

 The first 2 authors contributed equally to the study and article.

 Cite this article as: Been JV, Rours IGIJG, Kornelisse RF, et al. Histologic chorioamnionitis, fetal involvement, and antenatal steroids: effects on neonatal outcome in preterm infants. Am J Obstet Gynecol 2009;201:587.e1-8.

PII: S0002-9378(09)00647-4

doi:10.1016/j.ajog.2009.06.025

American Journal of Obstetrics & Gynecology
Volume 201, Issue 6 , Pages 587.e1-587.e8, December 2009