Elsevier

The Journal of Pediatrics

Volume 184, May 2017, Pages 62-67.e2
The Journal of Pediatrics

Original Articles
Maternal Chorioamnionitis and Postneonatal Respiratory Tract Infection in Ex-Preterm Infants

https://doi.org/10.1016/j.jpeds.2017.01.037Get rights and content

Objective

To assess whether exposure to histologically confirmed chorioamnionitis (ie, histologic chorioamnionitis [HCA]) is associated with altered risk of infection-related hospitalization (IRH) during the first 24 months of life in very preterm infants.

Study design

This single-center retrospective cohort study analyzed data on 1218 infants born at <30 weeks gestational age (GA). Semiquantitative placental histology, obstetric, and neonatal data were extracted from hospital databases and linked with discharge diagnoses on rehospitalization until age 24 months from statewide statutory data. The associations between HCA and overall and clinical categories of IRH were analyzed by Cox proportional hazards regression with left-truncated failure times.

Results

Mean GA was 27 weeks, and HCA was present in 577 placentas (47.4%). Among the 1088 infants surviving until the birth-related discharge, 684 (62.9%) of had at least 1 IRH by age 24 months, of whom 287 included a diagnosis of acute lower respiratory tract infection (ALRTI). Following adjustment for sex, birth weight z-score, GA, early-onset sepsis, late-onset sepsis, previous antibiotic use, age at birth-related discharge, and chronic lung disease, HCA was associated with a 32% increased risk of hospitalization with ALRTI (HR, 1.32; 95% CI, 1.02-1.70; P = .033). There was no association with infection overall or with other infection categories.

Conclusions

HCA is associated with a significantly increased risk of hospitalization with ALRTI that is independent of known risk factors, including chronic lung disease.

Section snippets

Methods

We included infants of 220/7 to 296/7 weeks GA born at the only tertiary perinatal center (King Edward Memorial Hospital, ~6000 births per annum) in Western Australia (current population 2.58 million) between January 1, 2001, and December 31, 2012. We excluded infants in whom placental histology was not performed and those with major congenital abnormalities that might increase the risk of early childhood infection. Detailed demographic, maternal, perinatal, and neonatal data were extracted

Results

A total of 1317 infants were born between 220/7 and 296/7 weeks GA during the study period. Of these, 92 infants were excluded owing to missing placental histology and 7 were excluded because of major congenital malformations. A total of 1218 infants were included in the final analysis of birth outcomes, and 1088 infants discharged to home were included in the final analysis of outcomes up to age 24 months. In the entirestudy cohort, the median GA at delivery was 27.0 weeks (IQR, 27.4-28.6

Discussion

In this large single-center retrospective study of preterm infants, HCA was associated with an increased risk of hospitalization with ALRTI in the first 2 years of life. The association was independent of key covariates that are known to increase infection risk overall, such as GA and BW17; those that specifically increase the risk of respiratory infections, such as CLD19; and those that are plausible but unproven, such as previous neonatal infection and early-life exposure to broad-spectrum

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    Supported by an AstraZeneca Fellowship of the Royal Australasian College of Physicians (to T.S.). D.B. is supported by an Australian National Health and Medical Research Council (NHMRC) Fellowship (APP1064629) and is an Honorary Future Leader Fellow of the National Heart Foundation of Australia. Research at Murdoch Childrens Research Institute is supported by the Victorian Government's Operational Infrastructure Support Program. Research at the Centre for Neonatal Research and Education is supported by the NHMRC Centre of Research Excellence (APP1057514, to K.S., T.S., and D.B.). The authors declare no conflicts of interest.

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