OBJECTIVETo explore the association between chorioamnionitis and brain injury in preterm infants.

METHODSA total of 88 preterm infants (28-34 weeks), who were born between June 2008 and June 2011, were divided into a case group (n=41) and a control group (n=47) according to whether or not they had chorioamnionitis. All the infants were examined by brain ultrasonography periodically after birth and underwent brain diffusion weighted imaging (DWI) between 3 and 7 days after birth. The two groups were compared in terms of the incidence of periventricular leukomalacia (PVL) and periventricular and intraventricular hemorrhage (PVH-IVH) by brain magnetic resonance imaging (MRI) at the corrected gestational age of 40 weeks.

RESULTSThere was statistical significance in the incidence of PVL between the case and the control groups (32% vs 6%; P<0.05), but no significant difference in the incidence of PVH-IVH between the two groups (27% vs 23%; P>0.05).

CONCLUSIONSChorioamnionitis is associated with brain injury in preterm infants, increasing the incidence of PVL but having little influence over the incidence of PVH-IVH.

Cerebral Hemorrhage ; epidemiology ; Chorioamnionitis ; Diffusion Magnetic Resonance Imaging ; Female ; Humans ; Incidence ; Infant, Newborn ; Infant, Premature ; Leukomalacia, Periventricular ; epidemiology ; Male ; Pregnancy

OBJECTIVE: To study the association of different stages of histological chorioamnionitis (HCA) with the incidence rate and severity of respiratory distress syndrome (RDS) in preterm infants. METHODS: Related data were collected from the infants and their mothers who were treated in the Neonatal Intensive Care Unit of Qingdao Women and Children's Hospital, Qingdao University, from January 2018 to June 2020. According to the presence or absence of HCA and its stage, the infants were divided into four groups: control ( RESULTS: Compared with the control and late-stage HCA groups, the early-stage HCA group had a significantly lower incidence rate of placental abruption and a significantly higher rate of prenatal use of antibiotics ( CONCLUSIONS Early-, middle-, and late-stage HCA can reduce the incidence rate of RDS in preterm infants. HCA stage may not be correlated with RDS severity in preterm infants, which needs to be verified by further research.
Birth Weight ; Child ; Chorioamnionitis/epidemiology* ; Female ; Gestational Age ; Humans ; Infant ; Infant, Newborn ; Infant, Premature ; Pregnancy ; Respiratory Distress Syndrome, Newborn/etiology*

OBJECTIVE: This study was performed to determine the benefits and risks of multiple courses of corticosteroids in patients with preterm premature rupture of membranes (PPROM). METHODS: We retrospectively evaluated the pregnancy and neonatal outcomes for women of singleton pregnancy with PPROM admitted at 24-32 weeks of gestation. Patients were categorized into 3 groups according to antenatal corticosteroids exposure: (1) non-user group, (2) single-course group, (3) multiple-course group. Chi-square test, analysis of variances, Kruskal-Wallis test, and multiple logistic regression analysis were used for statistical analyses. RESULTS: A total of 170 patients were included, with 50 in non-use group, 76 in single-course group, and 44 in multiple-course group. Univariate analyses showed that clinical chorioamnionitis occurred in the highest incidence in multiple-course group (x2=6.20, p<0.05) and the decreased incidence of RDS in multiple-course group (x2=10.0, p<0.01). Multiple logistic regression analyses demonstrated that no significant association was found after adjustment of confounding variables (odds ratio=0.28, p=0.063) whereas multiple courses of corticosteroids were independently associated with clinical chorioamnionitis (odds ratio=13.15, p=0.025). CONCLUSION: Multiple courses of antenatal corticosteroids therapy did not reduce the incidence of RDS in neonates and were associated with increased risk of clinical chorioamnionitis in patients with PPROM.
Adrenal Cortex Hormones ; Chorioamnionitis ; Confounding Factors (Epidemiology) ; Female ; Humans ; Incidence ; Infant, Newborn ; Logistic Models ; Membranes* ; Pregnancy ; Retrospective Studies ; Risk Assessment* ; Rupture*

OBJECTIVE: To determine the frequency and clinical significance of intra-amniotic inflammation (IAI) defined as an elevated amniotic fluid (AF) matrix metalloproteinase-8 (MMP-8) concentration in patients with preterm labor and intact membranes (PTL) and low AF white blood cell (WBC) counts. METHODS: Adverse pregnancy outcomes were compared according to the presence or absence of IAI in 220 singleton gestations who underwent amniocentesis due to PTL (gestational age<35.7 weeks) and had low AF WBC counts (<19 cells/mm3). Adverse pregnancy outcomes included preterm birth within 5 days of amniocentesis, acute histologic chorioamnionitis (acute-HCA) and positive AF culture. IAI was defined as an elevated AF MMP-8 concentration (> or =23 ng/mL). RESULTS: IAI was present in 19% of study population. Adverse pregnancy outcomes were significantly more frequent in patients with IAI than in those without IAI (preterm birth within 5 days of amniocentesis, 88% vs. 41%; acute-HCA, 47% vs. 11%; positive AF culture, 10% vs. 2%; each for P<0.05). Patients with IAI had a significantly shorter median amniocentesis-to-delivery interval than those without IAI (7.8 hours [0.01-3,307.3 hours] vs. 310.3 hours [0.01-2,973.8 hours]; P<0.001 from survival analysis). Multiple logistic regression analysis demonstrated that only an IAI (odds ratio, 3.3; 95% confidence interval, 1.5-7.3; P<0.005) retained a statistical significance in the prediction of acute-HCA after other confounding variables were adjusted. CONCLUSION: Approximately one-fifth of patients with PTL and low AF WBC counts have an evidence of IAI and are at risk for impending preterm delivery and acute-HCA when AF MMP-8 concentration is used.
Amniocentesis ; Amniotic Fluid ; Chorioamnionitis ; Confounding Factors (Epidemiology) ; Female ; Humans ; Inflammation ; Leukocyte Count ; Leukocytes ; Logistic Models ; Matrix Metalloproteinase 8 ; Membranes ; Obstetric Labor, Premature ; Parturition ; Pregnancy ; Pregnancy Outcome ; Premature Birth

OBJECTIVE: To study the influence of premature rupture of membranes (PROM) on the early prognosis of extremely premature infants, and to provide a basis for the management of extremely premature infants and prenatal consultation. METHODS: A total of 179 extremely premature singleton infants who were born from 2017 to 2019 were enrolled. According to the presence or absence of PROM, they were divided into two groups: PROM group ( RESULTS: Compared with the non-PROM group, the PROM group had significantly higher incidence rates of earlyonset sepsis and necrotizing enterocolitis (NEC) ( CONCLUSIONS PROM increases the incidence rates of early-onset sepsis and NEC in extremely premature infants and does not increase the incidence rates of other adverse outcomes. For pregnant women with PROM at the risk of extremely preterm delivery, prevention of miscarriage and chorioamnionitis is recommended to prolong gestational weeks, reduce the incidence rate of infection, and thus improve the outcome of extremely premature infants.
Chorioamnionitis ; Enterocolitis, Necrotizing/etiology* ; Female ; Fetal Membranes, Premature Rupture/epidemiology* ; Gestational Age ; Humans ; Infant ; Infant, Extremely Premature ; Infant, Newborn ; Pregnancy ; Prognosis

Conflicting results on the influences of histologic chorioamnionitis (HC) on neonatal morbidities might be partly originated from using different definition of HC. The aim of this study was to determine the relationship between HC and neonatal morbidities using definition of HC that reflects the site and extent of inflammation. This was a retrospective cohort study of 261 very low birth weight (VLBW) infants admitted at a tertiary academic center. Based on the site of inflammation, HC was categorized: any HC; amnionitis; funisitis; amnionitis+funisitis. The extent of inflammation in each site was reflected by sub-defining high grade (HG). The incidences of morbidities in infants with and without HC were compared. The bronchopulmonary dysplasia (BPD) rate was significantly higher in infants with amnionitis and the severe retinopathy of prematurity (ROP) rate was significantly higher in infants with any HC and funisitis. After adjustment for both gestational age and birth weight, the respiratory distress syndrome (RDS) rate was significantly lower in infants with all categories of HC except for HG amnionitis and HG funisitis, which are not associated with lower RDS rate. HG amnionitis was significantly associated with increased BPD rate but the association of HC with severe ROP disappeared. In conclusion, HC is significantly associated with decreased RDS and HG amnionitis with increased BPD while lacking association with other neonatal morbidities in VLBW infants. The association with HC and neonatal morbidities differs by the site and extent of chorioamnionitis.
Adult ; Birth Weight ; Bronchopulmonary Dysplasia/complications/*epidemiology ; Chorioamnionitis/classification/*epidemiology/pathology ; Cohort Studies ; Female ; Gestational Age ; Humans ; Infant, Newborn ; *Infant, Very Low Birth Weight ; Neutrophil Infiltration/immunology ; Placenta/pathology ; Pre-Eclampsia/*epidemiology/pathology ; Pregnancy ; Respiratory Distress Syndrome, Newborn/complications/*epidemiology ; Retinopathy of Prematurity/complications/*epidemiology ; Retrospective Studies ; Tertiary Care Centers

OBJECTIVE: Our purposes were (1) to determine whether amniotic fluid concentrations of tumor necrosis factor- are of value in the diagnosis of histologic chorioamnionitis of preterm placenta and in the prediction of congenital sepsis in patients with preterm labor and intact membranes and (2) to compare the diagnostic performance of placental histologic finding and amniotic fluid culture with that of amniotic fluid tumor necrosis factor- for this outcome variable. METHODS: The relations among placental histologic finding, perinatal outcome, amniotic fluid culture, and amniotic fluid tumor necrosis factor- concentrations were examined in 61 consecutive patients with preterm labor and intact membranes who delivered preterm neonates within 72 hours after transabdominal amniocentesis. Tumor necrosis factor- was determined by enzyme-linked immunosorbent assays. Mann-Whitney U test, Fisher's exact test, receiver-operator characteristic curve, and multiple logistic regression were used for analysis. RESULTS: 1) Women with acute histologic chorioamnionitis had significantly higher median amniotic fluid tumor necrosis factor- concentrations than those without histologic chorioamnionitis (median 83.2 pg/ml, range 1.4 to 7241 pg/ml vs median 1.6 pg/ml, range 0 to 59.9 pg/ml, p <0.0001). Amniotic fluid tumor necrosis factor- concentrations > or =4.6 pg/ml had a sensitivity of 88% (28/32) and specificity of 80% (23/29) in the diagnosis of acute histologic chorioamnionitis. 2) Amniotic fluid concentrations of tumor necrosis factor- were significantly higher in neonates with congenital sepsis than in those without congenital sepsis (median 227.5 pg/ml, range 1.2 to 7241 pg/ml vs median 3.8 pg/ml, range 0 to 735 pg/ml, p <0.0005). Amniotic fluid tumor necrosis factor- concentrations > or =41 pg/ml had a sensitivity of 82% (23/29) and specificity of 79% (38/48) in the prediction of congenital sepsis. 3) Multiple logistic regression indicated that elevated amniotic fluid tumor necrosis factor- (> or =41 pg/ml) was the only independent predictor of congenital sepsis (odd ratio 12.9, 95% confidence interval 1.3 to 125.3, p<0.05) after correction for known confounding variables [i.e., low gestational age at birth (< or =32 weeks), positive amniotic fluid culture, histologic or clinical chorioamnionitis, low Apgar score (<7)]. CONCLUSION: Test of amniotic fluid tumor necrosis factor- is of value in the antenatal diagnosis of histologic chorioamnionitis and congenital sepsis in patients with preterm labor and intact membranes. Amniotic fluid tumor necrosis factor- is a better independent predictor of congenital sepsis than placental histologic finding or amniotic fluid culture.
Amniocentesis ; Amniotic Fluid* ; Apgar Score ; Chorioamnionitis* ; Confounding Factors (Epidemiology) ; Diagnosis ; Enzyme-Linked Immunosorbent Assay ; Female ; Gestational Age ; Humans ; Infant, Newborn ; Logistic Models ; Membranes ; Necrosis* ; Obstetric Labor, Premature* ; Parturition ; Placenta ; Pregnancy ; Prenatal Diagnosis ; Sensitivity and Specificity ; Sepsis*

OBJECTIVE: Disseminated intravascular coagulation (DIC) is a serious and life-threatening complication of amniotic fluid embolism and chorioamnionitis. DIC results from excessive thrombin activity leading to a consumptive coagulopathy. The mechanisms responsible for the increased availability of thrombin in intrauterine infection remain to be elucidated. The purpose of this study was to determine if thrombin activation in amniotic fluid, as measured by thrombin-antithrombin III (TAT) concentration, was associated with intrauterine infection and preterm delivery. METHODS: A cross-sectional study included women who underwent transabdominal amniocentesis (n=129) in the following group: (1) mid-trimester (n=10) (2) preterm labor and intact membranes in the presence (n=17) or absence (n=72) of microbial invasion of the amniotic cavity, (3) term, not in labor and absence (n=30) of microbial invasion of the amniotic cavity. Intrauterine infection was defined as a positive amniotic fluid culture for microorganism. Thrombin was detected by assaying the thrombin-antithrombin III complex in amniotic fluid by means of sensitive and specific immunoassay (Enzygnost TAT micro; Behring Diagnostics Inc Westwood MA). RESULTS: 1) TAT complex was detected in all amniotic fluid samples and its concentration did not have a relation with gestational age. 2) The women with a positive amniotic fluid culture had a significantly higher median TAT complex concentration than those with a negative cultures (median, 168 micro gram/l; range, 23.1-288 vs median 80 micro gram/l; range, 10.7-507; p<0.05). 3) Multivariate analysis showed that amniotic fluid TAT complex was an independent predictor for preterm delivery (odd ratio 4.72, p<0.05) after correction for known confounding variables (i.e. gestational age, cervical dilatation at amniocentesis and positive amniotic fluid culture). CONCLUSION: This study showed that TAT complex in amniotic fluid was elevated in women with preterm labor and intact membranes who had a intrauterine infection or were destined to deliver before term. Our findings support the hypothesis that the excess thrombin released during the course of intrauterine infection may play a role in the genesis of DIC in this condition.
Amniocentesis ; Amniotic Fluid* ; Chorioamnionitis ; Confounding Factors (Epidemiology) ; Cross-Sectional Studies ; Dacarbazine ; Disseminated Intravascular Coagulation ; Embolism, Amniotic Fluid ; Female ; Gestational Age ; Humans ; Immunoassay ; Labor Stage, First ; Membranes ; Multivariate Analysis ; Obstetric Labor, Premature ; Parturition* ; Pregnancy ; Thrombin*

Preterm labor after 34 weeks of gestation has shown no great difference from fullterm labor in terms of neonatal morbidity and mortality when proper antepartum management (antibiotics or steroids treatment) is done. However, various studies have discussed different views on the risks and safety of preterm delivery at 32(+0)- 33(+6) weeks of gestation. We evaluated the complications of different preterm groups that included the neonates born at 32(+0)-33(+6) weeks of gestation (142), stratified randomly selected neonates born at 34(+0)-36(+6) weeks of gestation (267) and neonates born after 37(+0) weeks of gestation (356) at our hospital between December 1999 and April 2006. As a result, it was found that neonates born at 3(+0)-36(+6) weeks of gestation showed no great difference from infants born at full term. However, neonates born at 32(+0)-33(+6) weeks were more likely to be admitted to neonatal intensive care unit or develop neonatal complications significantly than the neonates born at 34(+0)- 36(+6) weeks and at full term. Therefore, it is suggested that neonates born at 32(+0)-33(+6) weeks have higher risk of neonatal complications following their preterm labor than those born at later than 34(+0) weeks. Thus, it would be difficult to accept the idea that preterm labor at 32(+0)-33(+6) weeks is safe.
Adult ; Anti-Bacterial Agents/therapeutic use ; Cardiotocography ; Chorioamnionitis/etiology ; Female ; Gestational Age ; Humans ; Infant, Newborn ; Infant, Premature ; Infant, Premature, Diseases/*epidemiology ; Infant, Small for Gestational Age ; Intensive Care Units, Neonatal ; Male ; Pregnancy ; Pregnancy Complications/epidemiology ; Premature Birth/mortality ; Retrospective Studies ; Steroids/therapeutic use