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Chorioamnionitis exposure associated with cognitive impairment, death
Extremely preterm infants exposed to chorioamnionitis before birth are at risk for cognitive impairment, death and neurodevelopmental impairment, according to recent study findings published in JAMA Pediatrics.
Athina Pappas, MD, of the Children’s Hospital of Michigan in Detroit, and colleagues examined 2,390 extremely preterm infants born at less than 27 weeks’ gestation between Jan. 1, 2006 and Dec, 31, 2008 to determine neonatal and neurodevelopmental outcomes when exposed to no chorioamnionitis, histological chorioamnionitis, or histological plus clinical chorioamnionitis. Patients were included if placental histopathology data and follow-up data to 18 to 22 months’ corrected age were available.
Thirty-eight percent of patients were born to mothers with histological chorioamnionitis alone and 19% to mothers with histological plus clinical chorioamnionitis. Lower gestational age (GA) and lower Apgar scores were associated with exposure to antenatal chorioamnionitis.
Overall, 1,376 patients were exposed to any type of chorioamnionitis. More patients exposed to histological plus clinical chorioamnionitis (51.2%) died by 18 to 22 months’ corrected age compared with 44.8% of patients exposed to histological chorioamnionitis alone; 46.1% with no exposure died.
At follow-up, patients exposed to histological plus clinical chorioamnionitis were more likely to have cognitive impairment compared with no exposure to chorioamnionitis (P=.02) and histological chorioamnionitis alone (P=.03).
Patients with histological plus clinical chorioamnionitis without GA were at increased risk for low cognitive score (OR=2.38; 95% CI, 1.32-4.28). Histological chorioamnionitis alone was associated with a decreased risk of death or neurodevelopmental impairment compared with histological plus clinical chorioamnionitis.
“Compared with unexposed neonates, neonates exposed to any chorioamnionitis had a lower GA and higher rates of early-onset sepsis and severe preventricular-intraventricular hemorrhage,” the researchers wrote. “In multivariable models evaluating death and neurodevelopmental outcomes, histological plus clinical chorioamnionitis was associated with increased risk of cognitive impairment as compared with no chorioamnionitis. Histological chorioamnionitis alone was associated with lower odds of death/[neurodevelopmental impairment] as compared with histological plus clinical chorioamnionitis. Histological chorioamnionitis alone was associated with lower odds of death/[neurodevelopmental impairment] as compared with the no chorioamnionitis group, but only when GA at delivery was included in the multivariable model. Both composite and noncomposite outcomes are presented because noncomposite outcomes ignore censoring from infant deaths.”
Disclosure: The study was funded in part by the Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Center for Research Resources, National Center for Advancing Translational Sciences, and NIH.
