Evaluation of Postnatal Complications in Clinical and Histological Chorioamnionitis in Extremely Preterm Infants: A Japanese Cohort Study

Author:

Ishida Shuji1ORCID,Nakanishi Hidehiko12,Sekiya Rika1,Kawada Kohei1,Kosaka Yukako1,Yamaguchi Ayano1,Ooka Mari1,

Affiliation:

1. Department of Pediatrics, Kitasato University, Sagamihara, Kanagawa, Japan

2. Division of Neonatal Intensive Care Medicine, Research and Development Center for New Medical Frontiers, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan

Abstract

Objective Terminating pregnancy appropriately before the intrauterine infection has progressed may have an improved prognosis for preterm infants. We evaluate how the combination of histological chorioamnionitis (hCAM) and clinical chorioamnionitis (cCAM) affects the short-term prognosis of infants. Study Design This retrospective multicenter cohort study based on the Neonatal Research Network of Japan included extremely preterm infants born weighing <1,500 g between 2008 and 2018. Demographic characteristics, morbidity, and mortality were compared between the cCAM(−)hCAM(+) and cCAM(+)hCAM(+) groups. Results We included 16,304 infants. The progression to cCAM in infants with hCAM was correlated with the increase in home oxygen therapy (HOT) (adjusted odds ratio [aOR], 1.27; 95% confidence interval [CI], 1.11–1.44) and persistent pulmonary hypertension of the newborn (PPHN) (1.20, 1.04–1.38). Furthermore, increased progression of the hCAM stage in infants with cCAM correlated with an increase in bronchopulmonary dysplasia (BPD; 1.05, 1.01–1.11), HOT (1.10, 1.02–1.18), and PPHN (1.09, 1.01–1.18). However, it had a negative impact on hemodynamically significant patent ductus arteriosus (hsPDA; 0.87, 0.83–0.92) and death before discharge from the neonatal intensive care unit (NICU; 0.88, 0.81–0.96). Conclusion Progression to cCAM in infants with hCAM positively correlated with HOT and PPHN. Progression of hCAM staging in infants with cCAM further increases the prevalence of BPD and the need for HOT and PPHN while reducing the prevalence of hsPDA and death before discharge from the NICU. The effects of the progressive hCAM stage in infants with cCAM vary from positive to negative by disease. Key Points

Publisher

Georg Thieme Verlag KG

Subject

Obstetrics and Gynecology,Pediatrics, Perinatology and Child Health

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