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Roberto Romero - One of the best experts on this subject based on the ideXlab platform.
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management of clinical Chorioamnionitis an evidence based approach
American Journal of Obstetrics and Gynecology, 2020Co-Authors: Agustin Condeagudelo, Roberto Romero, Eun Jung Jung, Angel Jose Garcia SanchezAbstract:This review aimed to examine the existing evidence about interventions proposed for the treatment of clinical Chorioamnionitis, with the goal of developing an evidence-based contemporary approach for the management of this condition. Most trials that assessed the use of antibiotics in clinical Chorioamnionitis included patients with a gestational age of ≥34 weeks and in labor. The first-line antimicrobial regimen for the treatment of clinical Chorioamnionitis is ampicillin combined with gentamicin, which should be initiated during the intrapartum period. In the event of a cesarean delivery, patients should receive clindamycin at the time of umbilical cord clamping. The administration of additional antibiotic therapy does not appear to be necessary after vaginal or cesarean delivery. However, if postdelivery antibiotics are prescribed, there is support for the administration of an additional dose. Patients can receive antipyretic agents, mainly acetaminophen, even though there is no clear evidence of their benefits. Current evidence suggests that the administration of antenatal corticosteroids for fetal lung maturation and of magnesium sulfate for fetal neuroprotection to patients with clinical Chorioamnionitis between 24 0/7 and 33 6/7 weeks of gestation, and possibly between 23 0/7 and 23 6/7 weeks of gestation, has an overall beneficial effect on the infant. However, delivery should not be delayed to complete the full course of corticosteroids and magnesium sulfate. Once the diagnosis of clinical Chorioamnionitis has been established, delivery should be considered, regardless of the gestational age. Vaginal delivery is the safer option and cesarean delivery should be reserved for standard obstetrical indications. The time interval between the diagnosis of clinical Chorioamnionitis and delivery is not related to most adverse maternal and neonatal outcomes. Patients may require a higher dose of oxytocin to achieve adequate uterine activity or greater uterine activity to effect a given change in cervical dilation. The benefit of using continuous electronic fetal heart rate monitoring in these patients is unclear. We identified the following promising interventions for the management of clinical Chorioamnionitis: (1) an antibiotic regimen including ceftriaxone, clarithromycin, and metronidazole that provides coverage against the most commonly identified microorganisms in patients with clinical Chorioamnionitis; (2) vaginal cleansing with antiseptic solutions before cesarean delivery with the aim of decreasing the risk of endometritis and, possibly, postoperative wound infection; and (3) antenatal administration of N-acetylcysteine, an antioxidant and antiinflammatory agent, to reduce neonatal morbidity and mortality. Well-powered randomized controlled trials are needed to assess these interventions in patients with clinical Chorioamnionitis.
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detection of microbial cell free dna in maternal and umbilical cord plasma in patients with Chorioamnionitis using next generation sequencing
PLOS ONE, 2020Co-Authors: Russell G Witt, Roberto Romero, Lily Blair, Michela Frascoli, Michael J Rosen, Quochung Nguyen, Sivan Bercovici, Simona Zompi, Tippi C MackenzieAbstract:Background Chorioamnionitis has been linked to spontaneous preterm labor and complications such as neonatal sepsis. We hypothesized that microbial cell-free (cf) DNA would be detectable in maternal plasma in patients with Chorioamnionitis and could be the basis for a non-invasive method to detect fetal exposure to microorganisms. Objective The purpose of this study was to determine whether next generation sequencing could detect microbial cfDNA in maternal plasma in patients with Chorioamnionitis. Study design Maternal plasma (n = 94) and umbilical cord plasma (n = 120) were collected during delivery at gestational age 28–41 weeks. cfDNA was extracted and sequenced. Umbilical cord plasma samples with evidence of contamination were excluded. The prevalence of microorganisms previously implicated in choriomanionitis, neonatal sepsis and intra-amniotic infections, as described in the literature, were examined to determine if there was enrichment of these microorganisms in this cohort. Specific microbial cfDNA associated with Chorioamnionitis was first detected in umbilical cord plasma and confirmed in the matched maternal plasma samples (n = 77 matched pairs) among 14 cases of histologically confirmed Chorioamnionitis and one case of clinical Chorioamnionitis; 63 paired samples were used as controls. A correlation of rank of a given microorganism across maternal plasma and matched umbilical cord plasma was used to assess whether signals found in umbilical cord plasma were also present in maternal plasma. Results Microbial DNA sequences associated with clinical and/or histological Chorioamnionitis were enriched in maternal plasma in cases with suspected Chorioamnionitis when compared to controls (12/14 microorganisms, p = 0.02). Analysis of the microbial cfDNA in umbilical cord plasma among the 1,251 microorganisms detectable with this assay identified Streptococcus mitis, Ureaplasma spp., and Mycoplasma spp. in cases of suspected Chorioamnionitis. This assay also detected cfDNA from Lactobacillus spp. in controls. Comparison between maternal plasma and umbilical cord plasma confirmed these signatures were also present in maternal plasma. Unbiased analysis of microorganisms with significantly correlated signal between matched maternal plasma and umbilical cord plasma identified the above listed 3 microorganisms, all of which have previously been implicated in patients with Chorioamnionitis (Mycoplasma hominis p = 0.0001; Ureaplasma parvum p = 0.002; Streptococcus mitis p = 0.007). These data show that the pathogen signal relevant for Chorioamnionitis can be identified in both maternal and umbilical cord plasma. Conclusion This is the first report showing the detection of relevant microbial cell-free cfDNA in maternal plasma and umbilical cord plasma in patients with clinical and/or histological Chorioamnionitis. These results may lead to the development of a specific assay to detect perinatal infections for targeted therapy to reduce early neonatal sepsis complications.
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cellular immune responses in amniotic fluid of women with preterm clinical Chorioamnionitis
Inflammation Research, 2020Co-Authors: Roberto Romero, Jose Galaz, Derek Miller, Rebecca Slutsky, Dustyn Levenson, Chaurdong HsuAbstract:Preterm birth is the leading cause of neonatal morbidity and mortality worldwide. Some preterm births are associated with clinical Chorioamnionitis; yet, this condition has been poorly investigated. Herein, we characterized the amniotic fluid cellular immune responses in women with preterm clinical Chorioamnionitis. Amniotic fluid samples were obtained from women with preterm clinical Chorioamnionitis and a positive or negative microbiological culture (n = 17). The cellular composition of amniotic fluid was evaluated using fluorescence microscopy, scanning and transmission electron microscopy, and flow cytometry. Women without preterm clinical Chorioamnionitis were also examined (n = 10). Amniotic fluid from women with preterm clinical Chorioamnionitis and a positive culture had: (1) abundant neutrophils associated with viable and non-viable bacteria, (2) neutrophils performing phagocytosis, (3) neutrophils forming NETs, (4) increased numbers of neutrophils, monocytes/macrophages, and CD4+ T cells, and (5) high expression of IL-1β by neutrophils and monocytes/macrophages. Amniotic fluid from women with preterm clinical Chorioamnionitis and proven infection tended to have fewer monocytes/macrophages and CD4+ T cells compared to those without Chorioamnionitis. We provide the first morphologic and phenotypic characterization of the cellular immune responses in the amniotic cavity of women with preterm clinical Chorioamnionitis, a condition associated with adverse neonatal outcomes.
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cxcl10 and il 6 markers of two different forms of intra amniotic inflammation in preterm labor
American Journal of Reproductive Immunology, 2017Co-Authors: Roberto Romero, Zhong Dong, Piya Chaemsaithong, Noppadol Chaiyasit, Nikolina Docheva, Chong Jai KimAbstract:Problem To determine whether amniotic fluid (AF) CXCL10 concentration is associated with histologic chronic Chorioamnionitis in patients with preterm labor (PTL) and preterm prelabor rupture of the membranes (PROM). Method of Study This study included 168 women who had an episode of PTL or preterm PROM. AF interleukin (IL)-6 and CXCL10 concentrations were determined by immunoassay. Results (i) Increased AF CXCL10 concentration was associated with chronic (OR: 4.8; 95% CI: 1.7-14), but not acute Chorioamnionitis; (ii) increased AF IL-6 concentration was associated with acute (OR: 4.2; 95% CI: 1.3-13.7) but not chronic Chorioamnionitis; and (iii) an increase in AF CXCL10 concentration was associated with placental lesions consistent with maternal anti-fetal rejection (OR: 3.7; 95% CI: 1.3-10.4). (iv) All patients with elevated AF CXCL10 and IL-6 delivered preterm. Conclusion Increased AF CXCL10 concentration is associated with chronic Chorioamnionitis or maternal anti-fetal rejection, whereas increased AF IL-6 concentration is associated with acute histologic Chorioamnionitis.
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twenty four percent of patients with clinical Chorioamnionitis in preterm gestations have no evidence of either culture proven intraamniotic infection or intraamniotic inflammation
American Journal of Obstetrics and Gynecology, 2017Co-Authors: Sun Min Kim, Joon Seok Hong, Eli Maymon, Offer Erez, Bogdan Panaitescu, Nardhy Gomezlopez, Roberto RomeroAbstract:Background Recent studies on clinical Chorioamnionitis at term suggest that some patients with this diagnosis have neither intraamniotic infection nor intraamniotic inflammation. A false-positive diagnosis of clinical Chorioamnionitis in preterm gestation may lead to unwarranted preterm delivery. Objective We sought to determine the frequency of intraamniotic inflammation and microbiologically proven amniotic fluid infection in patients with preterm clinical Chorioamnionitis. Study Design Amniocentesis was performed in singleton pregnant women with preterm clinical Chorioamnionitis ( 23 ng/mL. Nonparametric and survival techniques were used for analysis. Results Among patients with preterm clinical Chorioamnionitis, 24% (12/50) had neither microbiologic evidence of intraamniotic infection nor intraamniotic inflammation. Microbial invasion of the amniotic cavity was present in 34% (18/53) and intraamniotic inflammation in 76% (38/50) of patients. The most common microorganisms isolated from the amniotic cavity were the Ureaplasma species. Finally, patients without microbial invasion of the amniotic cavity or intraamniotic inflammation had significantly lower rates of adverse outcomes (including lower gestational age at delivery, a shorter amniocentesis-to-delivery interval, acute histologic Chorioamnionitis, acute funisitis, and significant neonatal morbidity) than those with microbial invasion of the amniotic cavity and/or intraamniotic inflammation. Conclusion Among patients with preterm clinical Chorioamnionitis, 24% had no evidence of either intraamniotic infection or intraamniotic inflammation, and 66% had negative amniotic fluid cultures, using standard microbiologic techniques. These observations call for a reexamination of the criteria used to diagnose preterm clinical Chorioamnionitis.
Saavedra Gómez, Cynthia Pamela - One of the best experts on this subject based on the ideXlab platform.
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Características clínicas y epidemiológicas del recién nacido con bajo peso al nacer en el Servicio de Neonatología del Hospital Santa Gema de Yurimaguas. Periodo 2015 - 2018
Universidad Nacional de San Martín - Tarapoto, 2020Co-Authors: Saavedra Gómez, Cynthia PamelaAbstract:El estudio de Características Clínicas y Epidemiológicas del Recién Nacido con Bajo Peso al Nacer en el Servicio de Neonatología del Hospital Santa Gema de Yurimaguas en el Periodo 2015 al 2018, tuvo como objetivo determinar las características clínicas y epidemiológicas del recién nacido con bajo peso al nacer en el servicio de neonatología del Hospital Santa Gema de Yurimaguas. Periodo 2015-2018, el tipo de investigación utilizado fue no experimental, cuantitativo descriptivo de corte transversal, la población y muestra que se utilizó fue 101 de casos de RNBPN. La técnica seleccionada para esta investigación fue la encuesta y como instrumento se usó el cuestionario. Se obtuvo como Resultados, que la edad materna predomina el rango de 15 a 35 años con un 52%, seguido de >35 años con un 32% y = 6 controles un 38%, sobre los antecedentes obstétricos, presentan Infección Urinaria un 57%, Anemia un 30%, Diabetes Gestacional un 5%, Oligoamnios un 4%, RPM > 18 horas un 3%, y Corioamnionitis un 1%.En los Antecedentes Natales existe en el Peso al Nacer un 90% peso 35 years with 32% and = 6 controls 38%, on obstetric history, had Urinary Infection 57%, Anemia 30%, Gestational Diabetes 5%, Oligoamnios 4% , RPM> 18 hours 3%, and Chorioamnionitis 1%. In the Birth Record, there was 90% of birth-weight
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Características clínicas y epidemiológicas del recién nacido con bajo peso al nacer en el Servicio de Neonatología del Hospital Santa Gema de Yurimaguas. Periodo 2015 - 2018
Universidad Nacional de San Martín - Tarapoto, 2020Co-Authors: Saavedra Gómez, Cynthia PamelaAbstract:The study of Clinical and Epidemiological Characteristics of the Newborn with Low Birth-Weight in the Neonatology Service of the Santa Gema Hospital - Yurimaguas in the Period 2015 to 2018, aimed at determining the clinical and epidemiological characteristics of the newborn with low birth-weight in the neonatology service of the Santa Gema Hospital- Yurimaguas in the Period 2015-2018. The type of research was non-experimental, quantitative descriptive cross-sectional. The population and sample was non-random and consisted of 101 cases of RNBPN. The technique selected for this research was the survey and the questionnaire was the selected instrument. The results showed that the maternal age predominates in the range of 15 to 35 years with 52%, followed by > 35 years with 32% and = 6 controls 38%, on obstetric history, had Urinary Infection 57%, Anemia 30%, Gestational Diabetes 5%, Oligoamnios 4% , RPM> 18 hours 3%, and Chorioamnionitis 1%. In the Birth Record, there was 90% of birth-weight 35 años con un 32% y = 6 controles un 38%, sobre los antecedentes obstétricos, presentan Infección Urinaria un 57%, Anemia un 30%, Diabetes Gestacional un 5%, Oligoamnios un 4%, RPM > 18 horas un 3%, y Corioamnionitis un 1%.En los Antecedentes Natales existe en el Peso al Nacer un 90% peso < 2,500 gramos, un 10%, peso < 1,000 gramos. En la Edad Gestacional, existe un 74% de
Kenneth J Leveno - One of the best experts on this subject based on the ideXlab platform.
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incidence of early onset sepsis in infants born to women with clinical Chorioamnionitis
Journal of Perinatal Medicine, 2018Co-Authors: Kenneth J Leveno, Tara M Randis, Madeline Murguia Rice, Leslie Myatt, Alan T N Tita, Uma M Reddy, Michael W Varner, John M Thorp, Brian M MercerAbstract:Objective To determine the frequency of sepsis and other adverse neonatal outcomes in women with a clinical diagnosis of Chorioamnionitis. Methods We performed a secondary analysis of a multi-center placebo-controlled trial of vitamins C/E to prevent preeclampsia in low risk nulliparous women. Clinical Chorioamnionitis was defined as either the "clinical diagnosis" of Chorioamnionitis or antibiotic administration during labor because of an elevated temperature or uterine tenderness in the absence of another cause. Early-onset neonatal sepsis was categorized as "suspected" or "confirmed" based on a clinical diagnosis with negative or positive blood, urine or cerebral spinal fluid cultures, respectively, within 72 h of birth. Adjusted odds ratios (ORs) and 95% confidence intervals (CIs) were estimated by logistic regression. Results Data from 9391 mother-infant pairs were analyzed. The frequency of Chorioamnionitis was 10.3%. Overall, 6.6% of the neonates were diagnosed with confirmed (0.2%) or suspected (6.4%) early-onset sepsis. Only 0.7% of infants born in the setting of Chorioamnionitis had culture-proven early-onset sepsis versus 0.1% if Chorioamnionitis was not present. Clinical Chorioamnionitis was associated with both suspected [OR 4.01 (3.16-5.08)] and confirmed [OR 4.93 (1.65-14.74)] early-onset neonatal sepsis, a need for resuscitation within the first 30 min after birth [OR 2.10 (1.70-2.61)], respiratory distress [OR 3.14 (2.16-4.56)], 1 min Apgar score of ≤3 [OR 2.69 (2.01-3.60)] and 4-7 [OR 1.71 (1.43-2.04)] and 5 min Apgar score of 4-7 [OR 1.67 (1.17-2.37)] (vs. 8-10). Conclusion Clinical Chorioamnionitis is common and is associated with neonatal morbidities. However, the vast majority of exposed infants (99.3%) do not have confirmed early-onset sepsis.
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the maternal fetal medicine units cesarean registry Chorioamnionitis at term and its duration relationship to outcomes
American Journal of Obstetrics and Gynecology, 2004Co-Authors: Dwight J Rouse, Steve N Caritis, Kenneth J Leveno, Michael W Varner, Mark B Landon, Sharon Leindecker, Mary Jo Osullivan, Ronald J Wapner, Paul J Meis, Menachem MiodovnikAbstract:Abstract Objective The purpose of this study was to evaluate the relationship between Chorioamnionitis and its duration to adverse maternal, fetal, and neonatal outcomes. Study design This was a 13-university center, prospective observational study. All women at term carrying a singleton gestation who underwent primary cesarean from January 1, 1999 to December 31, 2000 were eligible. Data abstraction was systematic and performed by trained research nurses. Selected adverse outcomes were compared between pregnancies with, and without, clinically diagnosed Chorioamnionitis using relative risks (RRs) and 95% CIs. The duration of Chorioamnionitis was stratified into 5 intervals (≤3 h,>3-6 h,>6-9 h,>9-12 h, and>12 h), and respective outcomes compared by Mantel-Haenszel test for trend. Additionally, regression analysis was used to compute odds ratios (ORs) and 95% CIs for Chorioamnionitis duration length as a continuous explanatory variable. Results 16,650 pregnancies were analyzed, 1965 (12%) with Chorioamnionitis, which was associated with significantly increased risks of maternal blood transfusion, uterine atony, septic pelvic thrombophlebitis, and pelvic abscess (RR 2.3-3.7), as well as 5-minute Apgar ≤3, neonatal sepsis, and seizures (RR 2.1-2.8). By test of trend, only uterine atony ( P P =.03), maternal admission to intensive care unit ( P =.02), and 5-minute Apgar ≤3 ( P Conclusion Chorioamnionitis was associated with increased rates of morbidity after cesarean at term. The duration of Chorioamnionitis, however, was not related to most measures of adverse maternal or fetal-neonatal outcome.
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Chorioamnionitis and the prognosis for term infants
Obstetrics & Gynecology, 1999Co-Authors: James M Alexander, Donald M Mcintire, Kenneth J LevenoAbstract:Abstract Objective: To assess the effects of clinical Chorioamnionitis and labor complications on short-term neonatal morbidity, including seizures. Methods: This was a retrospective cohort study of all live-born term infants who weighed more than 2500 g delivered between 1988 and 1997 at Parkland Memorial Hospital, Dallas, Texas. Infant outcomes were compared between women with and without clinical diagnoses of Chorioamnionitis. Chorioamnionitis was based on maternal fever of 38C or greater with supporting clinical evidence including fetal tachycardia, uterine tenderness, and malodorous infant. Results: A total of 101,170 term infants were analyzed, 5144 (5%) of whom were born to women with Chorioamnionitis. Apgar scores of 3 or less at 5 minutes, umbilical artery pH of 7.0 or less, delivery-room intubation, sepsis, pneumonia, seizures in the first 24 hours, and meconium aspiration syndrome were all increased in infants exposed to Chorioamnionitis. After adjustment for confounding factors, including route of delivery and length of labor, Chorioamnionitis remained significantly associated with intubation in the delivery room (odds ratio [OR] 2.0; 95% confidence interval [CI] 1.5, 2.6), pneumonia (OR 2.2; 95% CI 1.7, 2.8), and sepsis (OR 2.9; 95% CI 2.1, 4.1). Short-term neurologic morbidity, manifest as seizures, was not related to maternal infection during labor, but was significantly related to other labor complications. Conclusion: The main short-term neonatal consequence of Chorioamnionitis is infection. Short-term neurologic morbidity in infants is related to labor complications and not Chorioamnionitis per se.
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clinical Chorioamnionitis and the prognosis for very low birth weight infants
Obstetrics & Gynecology, 1998Co-Authors: James M Alexander, Donald M Mcintire, Larry C Gilstrap, Susan M Cox, Kenneth J LevenoAbstract:Abstract Objective: To determine the effects of clinical Chorioamnionitis on neonatal morbidity and mortality in very low birth weight infants. Methods: This was an observational cohort analysis of all singleton live-born infants weighing 500–1500 g at 24 weeks’ or greater gestational age and born between 1988 and 1996 at Parkland Memorial Hospital, Dallas, Texas. Chorioamnionitis was diagnosed on the basis of maternal fever of 38C with supporting clinical evidence, which included fetal tachycardia, uterine tenderness, and/or malodorous infant, and the absence of another source of infection. Multiple logistic regression analysis was used to adjust for outcomes of interest. Results: Ninety-five of 1367 very low birth weight infants (7%) were exposed to Chorioamnionitis. Neonatal sepsis, respiratory distress syndrome, seizure in the first 24 hours of life, intraventricular hemorrhage (grade 3 or 4), and periventricular leukomalacia were all significantly increased with Chorioamnionitis, after adjusting for preterm ruptured membranes, pregnancy-associated hypertension, cesarean birth, gestational age, and birth weight. The odds ratios for intraventricular hemorrhage, periventricular leukomalacia, and seizures in the first 24 hours were 2.8 (95% confidence interval [CI] 1.6, 4.8), 3.4 (95% CI 1.6, 7.3), and 2.9 (95% CI 1.2, 6.8), respectively. Conclusion: Our results suggest a link between clinical Chorioamnionitis and several indices of neonatal morbidity in the very low birth weight infant. Chorioamnionitis appears to make the very low birth weight infant particularly vulnerable to neurologic damage.
David Burgner - One of the best experts on this subject based on the ideXlab platform.
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exposure to Chorioamnionitis alters the monocyte transcriptional response to the neonatal pathogen staphylococcus epidermidis
Immunology and Cell Biology, 2018Co-Authors: Emma De Jong, David Burgner, David G Hancock, Christine A Wells, Peter Richmond, Karen Simmer, Tobias StrunkAbstract:Preterm infants are uniquely susceptible to late-onset sepsis that is frequently caused by the skin commensal Staphylococcus epidermidis. Innate immune responses, particularly from monocytes, are a key protective mechanism. Impaired cytokine production by preterm infant monocytes is well described, but few studies have comprehensively assessed the corresponding monocyte transcriptional response. Innate immune responses in preterm infants may be modulated by inflammation such as prenatal exposure to histologic Chorioamnionitis which complicates 40-70% of preterm pregnancies. Chorioamnionitis alters the risk of late-onset sepsis, but its effect on monocyte function is largely unknown. Here, we aimed to determine the impact of exposure to Chorioamnionitis on the proportions and phenotype of cord blood monocytes using flow cytometry, as well as their transcriptional response to live S. epidermidis. RNA-seq was performed on purified cord blood monocytes from very preterm infants (<32 weeks gestation, with and without Chorioamnionitis-exposure) and term infants (37-40 weeks), pre- and postchallenge with live S. epidermidis. Preterm monocytes from infants without Chorioamnionitis-exposure did not exhibit an intrinsically deficient transcriptional response to S. epidermidis compared to term infants. In contrast, Chorioamnionitis-exposure was associated with hypo-responsive transcriptional phenotype regarding a subset of genes involved in antigen presentation and adaptive immunity. Overall, our findings suggest that prenatal exposure to inflammation may alter the risk of sepsis in preterm infants partly by modulation of monocyte responses to pathogens.
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inflammation lipids and aortic intima media thickness in newborns following Chorioamnionitis
Acta Paediatrica, 2016Co-Authors: Anthony R Rafferty, Lorraine Mcgrory, Sheryle Rogerson, Diana Ziannino, Jan Pyman, Michael Cheung, Peter G Davis, David BurgnerAbstract:AIM: This study investigated whether Chorioamnionitis was associated with increased inflammation, dyslipidaemia and adverse cardiovascular phenotypes in the immediate postnatal period. METHODS: This prospective case-control study included preterm infants (30(+0) -35(+6) weeks gestational age, GA) whose mothers did not have pregnancy-related conditions that may influence outcomes. Chorioamnionitis was diagnosed by placental histology, and infants were divided retrospectively into cases (Chorioamnionitis-exposed) and controls (unexposed). Serum high-sensitivity C-reactive protein (hsCRP), lipid profile, far-wall abdominal aortic intima-media thickness (aIMT) and blood pressure (BP) were measured in the first week of life. RESULTS: There were 20 (16 male, mean GA 32.4 weeks) cases and 31 (12 male, mean GA 32.6 weeks) controls. Histological Chorioamnionitis was associated with a significant increase in hsCRP and a non-significant trend towards an adverse lipid profile. There was no evidence of differences in aIMT or BP. CONCLUSION: Preterm infants exposed to Chorioamnionitis have greater postnatal inflammation. There were no early postnatal differences in aIMT or BP. The inflammatory stimulus of Chorioamnionitis late in gestation may be of insufficient intensity and duration to result in immediate postnatal alterations to arterial structure. Cardiovascular follow-up of infants exposed to Chorioamnionitis may identify differential risk trajectories and subsequent inflammatory responses.
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inflammation lipids and aortic intima media thickness in newborns following Chorioamnionitis
Acta Paediatrica, 2016Co-Authors: Anthony R Rafferty, Lorraine Mcgrory, Sheryle Rogerson, Diana Ziannino, Jan Pyman, Michael Cheung, Peter G Davis, David BurgnerAbstract:AIM: This study investigated whether Chorioamnionitis was associated with increased inflammation, dyslipidaemia and adverse cardiovascular phenotypes in the immediate postnatal period. METHODS: This prospective case-control study included preterm infants (30(+0) -35(+6) weeks gestational age, GA) whose mothers did not have pregnancy-related conditions that may influence outcomes. Chorioamnionitis was diagnosed by placental histology, and infants were divided retrospectively into cases (Chorioamnionitis-exposed) and controls (unexposed). Serum high-sensitivity C-reactive protein (hsCRP), lipid profile, far-wall abdominal aortic intima-media thickness (aIMT) and blood pressure (BP) were measured in the first week of life. RESULTS: There were 20 (16 male, mean GA 32.4 weeks) cases and 31 (12 male, mean GA 32.6 weeks) controls. Histological Chorioamnionitis was associated with a significant increase in hsCRP and a non-significant trend towards an adverse lipid profile. There was no evidence of differences in aIMT or BP. CONCLUSION: Preterm infants exposed to Chorioamnionitis have greater postnatal inflammation. There were no early postnatal differences in aIMT or BP. The inflammatory stimulus of Chorioamnionitis late in gestation may be of insufficient intensity and duration to result in immediate postnatal alterations to arterial structure. Cardiovascular follow-up of infants exposed to Chorioamnionitis may identify differential risk trajectories and subsequent inflammatory responses.
James M Alexander - One of the best experts on this subject based on the ideXlab platform.
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Chorioamnionitis and the prognosis for term infants
Obstetrics & Gynecology, 1999Co-Authors: James M Alexander, Donald M Mcintire, Kenneth J LevenoAbstract:Abstract Objective: To assess the effects of clinical Chorioamnionitis and labor complications on short-term neonatal morbidity, including seizures. Methods: This was a retrospective cohort study of all live-born term infants who weighed more than 2500 g delivered between 1988 and 1997 at Parkland Memorial Hospital, Dallas, Texas. Infant outcomes were compared between women with and without clinical diagnoses of Chorioamnionitis. Chorioamnionitis was based on maternal fever of 38C or greater with supporting clinical evidence including fetal tachycardia, uterine tenderness, and malodorous infant. Results: A total of 101,170 term infants were analyzed, 5144 (5%) of whom were born to women with Chorioamnionitis. Apgar scores of 3 or less at 5 minutes, umbilical artery pH of 7.0 or less, delivery-room intubation, sepsis, pneumonia, seizures in the first 24 hours, and meconium aspiration syndrome were all increased in infants exposed to Chorioamnionitis. After adjustment for confounding factors, including route of delivery and length of labor, Chorioamnionitis remained significantly associated with intubation in the delivery room (odds ratio [OR] 2.0; 95% confidence interval [CI] 1.5, 2.6), pneumonia (OR 2.2; 95% CI 1.7, 2.8), and sepsis (OR 2.9; 95% CI 2.1, 4.1). Short-term neurologic morbidity, manifest as seizures, was not related to maternal infection during labor, but was significantly related to other labor complications. Conclusion: The main short-term neonatal consequence of Chorioamnionitis is infection. Short-term neurologic morbidity in infants is related to labor complications and not Chorioamnionitis per se.
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clinical Chorioamnionitis and the prognosis for very low birth weight infants
Obstetrics & Gynecology, 1998Co-Authors: James M Alexander, Donald M Mcintire, Larry C Gilstrap, Susan M Cox, Kenneth J LevenoAbstract:Abstract Objective: To determine the effects of clinical Chorioamnionitis on neonatal morbidity and mortality in very low birth weight infants. Methods: This was an observational cohort analysis of all singleton live-born infants weighing 500–1500 g at 24 weeks’ or greater gestational age and born between 1988 and 1996 at Parkland Memorial Hospital, Dallas, Texas. Chorioamnionitis was diagnosed on the basis of maternal fever of 38C with supporting clinical evidence, which included fetal tachycardia, uterine tenderness, and/or malodorous infant, and the absence of another source of infection. Multiple logistic regression analysis was used to adjust for outcomes of interest. Results: Ninety-five of 1367 very low birth weight infants (7%) were exposed to Chorioamnionitis. Neonatal sepsis, respiratory distress syndrome, seizure in the first 24 hours of life, intraventricular hemorrhage (grade 3 or 4), and periventricular leukomalacia were all significantly increased with Chorioamnionitis, after adjusting for preterm ruptured membranes, pregnancy-associated hypertension, cesarean birth, gestational age, and birth weight. The odds ratios for intraventricular hemorrhage, periventricular leukomalacia, and seizures in the first 24 hours were 2.8 (95% confidence interval [CI] 1.6, 4.8), 3.4 (95% CI 1.6, 7.3), and 2.9 (95% CI 1.2, 6.8), respectively. Conclusion: Our results suggest a link between clinical Chorioamnionitis and several indices of neonatal morbidity in the very low birth weight infant. Chorioamnionitis appears to make the very low birth weight infant particularly vulnerable to neurologic damage.