Abstract
Objective
To characterize the association of histological chorioamnionitis (HCA) with neurodevelopmental outcomes in children born at <30 weeks gestation.
Study design
This retrospective cohort study included infants born 2006–2012 in whom placental histopathology, neonatal outcomes, and Bayley-III assessment at age 2 years were available. We assessed the association of HCA exposure with cognitive, language, and motor delay with logistic regression models adjusted for gestational age, sex, small for gestational age and brain injury.
Results
Of 1353 infants, 985 had histological and neonatal data available, and 708 infants had Bayley-III assessments. HCA-exposed infants were at higher risk of some neonatal adverse outcomes, and stage of HCA correlated with low Apgar score and early-onset sepsis. Exposure to HCA was not associated with neurodevelopmental outcomes in adjusted models including stage of HCA.
Conclusions
Exposure to HCA, especially higher stage, was associated with neonatal morbidity but not with adverse neurodevelopmental outcomes at 2 years of age.
This is a preview of subscription content, access via your institution
Access options
Subscribe to this journal
Receive 12 print issues and online access
$259.00 per year
only $21.58 per issue
Rent or buy this article
Prices vary by article type
from$1.95
to$39.95
Prices may be subject to local taxes which are calculated during checkout
Similar content being viewed by others
References
Blencowe H, Cousens S, Oestergaard MZ, Chou D, Moller AB, Narwal R, et al. National, regional, and worldwide estimates of preterm birth rates in the year 2010 with time trends since 1990 for selected countries: a systematic analysis and implications. Lancet. 2012;379:2162–72. (9832)
Lahra MM, Jeffery HE. A fetal response to chorioamnionitis is associated with early survival after preterm birth. Am J Obstet Gynecol. 2004;190:147–51.(1)
Hecht JL, Fichorova RN, Tang VF, Allred EN, McElrath TF, Leviton A. Relationship between neonatal blood protein concentrations and placenta histologic characteristics in extremely low GA newborns. Pediatr Res. 2011;69:68–73.(1)
Leviton A, Hecht JL, Allred EN, Yamamoto H, Fichorova RN, Dammann O. Persistence after birth of systemic inflammation associated with umbilical cord inflammation. J Reprod Immunol. 2011;90:235–43.(2)
Soraisham AS, Trevenen C, Wood S, Singhal N, Sauve R. Histological chorioamnionitis and neurodevelopmental outcome in preterm infants. J Perinatol. 2013;33:70–5.(1)
von Ehrenstein OS, Neta GI, Andrews W, Goldenberg R, Goepfert A, Zhang J. Child intellectual development in relation to cytokine levels in umbilical cord blood. Am J Epidemiol. 2012;175:1191–9.(11)
Hatfield T, Wing DA, Buss C, Head K, Muftuler LT, Davis EP. Magnetic resonance imaging demonstrates long-term changes in brain structure in children born preterm and exposed to chorioamnionitis. Am J Obstet Gynecol. 2011;205:384 e1–8.(4)
Rovira N, Alarcon A, Iriondo M, Ibanez M, Poo P, Cusi V, et al. Impact of histological chorioamnionitis, funisitis and clinical chorioamnionitis on neurodevelopmental outcome of preterm infants. Early Hum Dev. 2011;87:253–7.(4)
Shatrov JG, Birch SC, Lam LT, Quinlivan JA, McIntyre S, Mendz GL. Chorioamnionitis and cerebral palsy: a meta-analysis. Obstet Gynecol. 2010;116:387–92.(2 Pt 1)
Leviton A, Allred EN, Kuban KC, Hecht JL, Onderdonk AB, O’Shea TM, et al. Microbiologic and histologic characteristics of the extremely preterm infant’s placenta predict white matter damage and later cerebral palsy. the ELGAN study. Pediatr Res. 2010;67:95–101.
Ylijoki M, Ekholm E, Haataja L, Lehtonen L. Is chorioamnionitis harmful for the brain of preterm infants? A clinical overview. Acta Obstet Gynecol Scand. 2012;91:403–19.
Pugni L, Pietrasanta C, Acaia B, Merlo D, Ronchi A, Ossola MW, et al. Chorioamnionitis and neonatal outcome in preterm infants: a clinical overview. J Matern Fetal Neonatal Med. 2016;29:1525–9.
Redline RW, Faye-Petersen O, Heller D, Qureshi F, Savell V, Vogler C. Amniotic infection syndrome: nosology and reproducibility of placental reaction patterns. Pediatr Dev Pathol. 2003;6:435–48.
Strunk T, Doherty D, Jacques A, Simmer K, Richmond P, Kohan R, et al. Histologic chorioamnionitis is associated with reduced risk of late-onset sepsis in preterm infants. Pediatrics. 2012;129:e134–41.
Kim CJ, Romero R, Chaemsaithong P, Chaiyasit N, Yoon BH, Kim YM. Acute chorioamnionitis and funisitis: definition, pathologic features, and clinical significance. Am J Obstet Gynecol. 2015;213:S29–52. (4 Suppl)
Khong TY, Mooney EE, Ariel I, Balmus NC, Boyd TK, Brundler MA, et al. Sampling and definitions of placental lesions: amsterdam placental workshop group consensus statement. Arch Pathol Lab Med. 2016;140:698–713.
Hendson L, Russell L, Robertson CM, Liang Y, Chen Y, Abdalla A, et al. Neonatal and neurodevelopmental outcomes of very low birth weight infants with histologic chorioamnionitis. J Pediatr. 2011;158:397–402.
Bell MJ, Ternberg JL, Feigin RD, Keating JP, Marshall R, Barton L, et al. Neonatal necrotizing enterocolitis. Therapeutic decisions based upon clinical staging. Ann Surg. 1978;187:1–7.
Schmidt B, Asztalos EV, Roberts RS, Robertson CM, Sauve RS, Whitfield MF, et al. Impact of bronchopulmonary dysplasia, brain injury, and severe retinopathy on the outcome of extremely low-birth-weight infants at 18 months: results from the trial of indomethacin prophylaxis in preterms. JAMA. 2003;289:1124–9.
Papile LA, Munsick-Bruno G, Schaefer A. Relationship of cerebral intraventricular hemorrhage and early childhood neurologic handicaps. J Pediatr. 1983;103:273–7.
Jobe AH, Bancalari E. Bronchopulmonary dysplasia. Am J Respir Crit Care Med. 2001;163:1723–9.
Chen ML, Guo L, Smith LE, Dammann CE, Dammann O. High or low oxygen saturation and severe retinopathy of prematurity: a meta-analysis. Pediatrics. 2010;125:e1483–92.
Pink B. Socio-economic indexes for areas (SEIFA). Australian Bureau of Statistics. Canberra; 2013.
Anderson PJ, De Luca CR, Hutchinson E, Roberts G, Doyle LW.Victorian Infant Collaborative Group Underestimation of developmental delay by the new Bayley-III Scale. Arch Pediatr Adolesc Med. 2010;164:352–6.
Moore T, Johnson S, Haider S, Hennessy E, Marlow N. Relationship between test scores using the second and third editions of the Bayley Scales in extremely preterm children. J Pediatr. 2012;160:553–8.
Silveira RC, Filipouski GR, Goldstein DJ, O’Shea TM, Procianoy RS. Agreement between Bayley Scales second andthird edition assessments of very low-birth-weight infants. Arch Pediatr Adolesc Med. 2012;166:1075–6.
Dammann O, Leviton A. Intermittent or sustained systemic inflammation and the preterm brain. Pediatr Res. 2014;75:376–80.
O’Shea TM, Allred EN, Dammann O, Hirtz D, Kuban KC, Paneth N, et al. The ELGAN study of the brain and related disorders in extremely low gestational age newborns. Early Hum Dev. 2009;85:719–25.
Chawla S, Natarajan G, Shankaran S, Pappas A, Stoll BJ, Carlo WA, et al. Association of neurodevelopmental outcomes and neonatal morbidities of extremely premature infants with differential exposure to antenatal steroids. JAMA Pediatr. 2016;170:1164–72.
Huetz N, Triau S, Leboucher B, Sentilhes L, Hanf M, Nguyen S, et al. Association of severe placental inflammation with death prior to discharge and cerebral palsy in preterm infants. BJOG. 2016;123:1956–63.
van Vliet EO, de Kieviet JF, van der Voorn JP, Been JV, Oosterlaan J, van Elburg RM. Placental pathology and long-term neurodevelopment of very preterm infants. Am J Obstet Gynecol. 2012;206:489 e1–7.(6)
Schlapbach LJ, Ersch J, Adams M, Bernet V, Bucher HU, Latal B. Impact of chorioamnionitis and preeclampsia on neurodevelopmental outcome in preterm infants below 32 weeks gestational age. Acta Paediatr. 2010;99:1504–9.
Shi Z, Ma L, Luo K, Bajaj M, Chawla S, Natarajan G, et al. Chorioamnionitis in the Development of Cerebral Palsy: A Meta-analysis and Systematic Review. Pediatrics Jun 2017;139(6) e20163781; https://doi.org/10.1542/peds.2016-3781.
Jacobsson B, Hagberg G, Hagberg B, Ladfors L, Niklasson A, Hagberg H. Cerebral palsy in preterm infants: a population-based case-control study of antenatal and intrapartal risk factors. Acta Paediatr. 2002;91:946–51.
Linsell L, Malouf R, Morris J, Kurinczuk JJ, Marlow N. Prognostic factors for poor cognitive development in children born very preterm or with very low birth weight: a systematic review. JAMA Pediatr. 2015;169:1162–72.
Sawady J, Mercer BM, Wapner RJ, Zhao Y, Sorokin Y, Johnson F, et al. The National Institute of Child Health and Human Development Maternal-Fetal Medicine Units Network Beneficial Effects of Antenatal Repeated Steroids study: impact of repeated doses of antenatal corticosteroids on placental growth and histologic findings. Am J Obstet Gynecol. 2007;197:281 e1–8.(3)
Reddy UM, Goldenberg R, Silver R, Smith GC, Pauli RM, Wapner RJ, et al. Stillbirth classification--developing an international consensus for research: executive summary of a National Institute of Child Health and Human Development workshop. Obstet Gynecol. 2009;114:901–14.
Bright HR, Babata K, Allred EN, Erdei C, Kuban KCK, Joseph RM, et al. Neurocognitive outcomes at 10 years of age in extremely preterm newborns with late-onset bacteremia. J Pediatr. 2017;187:43–9.
Allred EN, Dammann O, Fichorova RN, Hooper SR, Hunter SJ, Joseph RM, et al. Systemic inflammation during the first postnatal month and the risk of attention deficit hyperactivity disorder characteristics among 10 year-old children born extremely preterm. J Neuroimmune Pharmacol. 2017;12:531–43.
Dammann O, Allred EN, Fichorova RN, Kuban K, O’Shea TM, Leviton A, et al. Duration of systemic inflammation in the first postnatal month among infants born before the 28th week of gestation. Inflammation. 2016;39:672–7.
Howman RA, Charles AK, Jacques A, Doherty DA, Simmer K, Strunk T, et al. Inflammatory and haematological markers in the maternal, umbilical cord and infant circulation in histological chorioamnionitis. PLoS ONE. 2012;7:e51836.
Gnanendran L, Bajuk B, Oei J, Lui K, Abdel-Latif ME, Network N. Neurodevelopmental outcomes of preterm singletons, twins and higher-order gestations: a population-based cohort study. Arch Dis Child Fetal Neonatal Ed. 2015;100:F106–14.
Funding
The study was supported by a Telethon Channel 7 Trust research grant to Catherine Campbell and Tobias Strunk.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
The authors declare that they have no conflict of interest.
Rights and permissions
About this article
Cite this article
Strunk, T., Campbell, C., Burgner, D. et al. Histological chorioamnionitis and developmental outcomes in very preterm infants. J Perinatol 39, 321–330 (2019). https://doi.org/10.1038/s41372-018-0288-3
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1038/s41372-018-0288-3
This article is cited by
-
Elevated neutrophil-lymphocyte ratios in extremely preterm neonates with histologic chorioamnionitis
Journal of Perinatology (2021)
-
Microbial invasion of the amniotic cavity is associated with impaired cognitive and motor function at school age in preterm children
Pediatric Research (2020)