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PubMed2000

Acute thymic involution in fetuses and neonates with chorioamnionitis.

Chorioamnionitis represents the leading cause of preterm birth and related pathologic conditions as well as of fetal death and frequently occurs in symptom-free mothers. Recent radiologic findings have indicated that thymus size is significantly reduced in preterm infants born to mothers with subclinical, histologically proven chorioamnionitis. However, an accurate morphologic description of the thymus gland in fetuses and neonates with chorioamnionitis is lacking, although it is known that infection and other stress processes may cause lymphocyte depletion in the thymuses of infants and older babies (acute stress involution). We describe morphologic modifications in the thymus of fetuses with histologically proven chorioamnionitis and newborn infants with chorioamnionitis and proven sepsis. The main findings included (1) decreased organ volume (ANOVA, P < .0024); (2) reduced corticomedullary ratio (P < 10(-6)); (3) significant changes in the relationship between thymic parenchyma and thymic interstitial tissue with resulting increased organ complexity (P = .03); (4) severe reduction of thymocytes; and (5) other degenerative processes such as monocyte/macrophage infiltration of Hassall's bodies. These results indicate that chorioamnionitis, with or without sepsis, is associated with significant morphologic modifications in the thymus. We wish to note that the described thymic pathology is only one aspect of the fetal systemic inflammatory response syndrome with which chorioamnionitis is associated.

Abortion, Spontaneous↗

PubMed2005

Outcome of neonates less than 30 weeks gestation with histologic chorioamnionitis.

The purpose of this study was to determine the short-term outcome of newborns less than 30 weeks gestation when there is definite placental histologic chorioamnionitis. A retrospective analysis was performed of records of all neonates delivered at our institution from January 1989 through January 1999. This information was retrieved from our perinatal database and pathology database. The population was stratified according to the presence or absence of histologic chorioamnionitis. Statistical analysis was performed using student t-test and Mann-Whitney method. Logistic regression was used to control for potential confounding variables. There were 392 neonates less than 30 weeks gestation delivered during this time period. Complete placental histology was available for 342 patients (87.4%). Histologic chorioamnionitis was identified in 140 (40.9%) cases. Those with histologic chorioamnionitis delivered sooner (26.3 versus 27.5 weeks), were of lower birth weight (920.1 versus 1029.8 g), and had lower 5-minute Apgarscores. Neonatal septicaemia and pneumonia were strongly associated with underlying histologic chorioamnionitis. There was a significant reduction in the incidence of respiratory distress syndrome (RDS) when histologic chorioamnionitis was present. Severe histologic chorioamnionitis increases the risk of premature delivery and is strongly associated with neonatal sepsis. There is a significant reduction in the incidence of RDS and neonatal mortality.

Chorioamnionitis↗

PubMed2003

Chorioamnionitis and increased neonatal lung lavage fluid matrix metalloproteinase-9 levels: implications for antenatal origins of chronic lung disease.

OBJECTIVE: Matrix metalloproteinase-9 (MMP-9) degrades type IV collagen, the major constituent of lung basement membrane. We studied the effects of chorioamnionitis and antenatal corticosteroids on bronchoalveolar lavage (BAL) fluid levels of MMP-9, and its inhibitor, TIMP-1 in preterm infants. STUDY DESIGN: A prospective study was performed on serial BAL samples from 79 ventilated preterm infants at less than 33 weeks' gestation, 18 of whom were from pregnancies complicated by chorioamnionitis. MMP-9 levels were measured by gelatin zymography and TIMP-1 by enzyme-linked immunosorbent assay, and the median value for each infant was calculated. The presence and severity of chorioamnionitis were defined histologically. RESULTS: BAL fluid MMP-9 levels were higher in preterm infants in the chorioamnionitis group (86 [29-518] vs 13 [3-43] ng/mL, P =.001), and levels increased stepwise with the increasing severity of chorioamnionitis. Antenatal corticosteroids had no effect on median MMP-9 levels. Infants in the chorioamnionitis group were more likely to have chronic lung disease (CLD) develop (55% vs 28%, P <.05). TIMP-1 levels were no different between groups. CONCLUSION: Chorioamnionitis is associated with increased lung type IV collagenase levels in the ventilated preterm infant. Antenatal lung inflammation with up-regulation of MMP-9 may be important in the pathogenesis of CLD.

Bronchoalveolar Lavage Fluid↗

PubMed2003

Regulation of FasL/Fas in human trophoblasts: possible implications for chorioamnionitis.

Chorioamnionitis is a common cause of premature birth and is associated with significant morbidity and mortality in the mother and infant. Preterm birth shares similarities with rejection of the fetal allograft, which is characterized by increased apoptosis of placental trophoblasts. We hypothesized that there is increased trophoblast apoptosis in chorioamnionitis and that this increased apoptosis is mediated by the Fas ligand (FasL)/Fas pathway. To test our hypothesis, we examined placental villous tissues from patients with chorioamnionitis and used the TUNEL assay to demonstrate enhanced trophoblast apoptosis in patients with chorioamnionitis. When the same samples were stained for Fas, there was increased trophoblast Fas expression in patients with chorioamnionitis. To define the mechanisms responsible for this increase in trophoblast apoptosis, we cultured villous explants from uncomplicated term placentas with proinflammatory cytokines and demonstrated a marked increase in trophoblast apoptosis. By blocking FasL, we reduced tumor necrosis factor alpha-induced and interferon gamma-induced apoptosis. These data suggest that chorioamnionitis is associated with increased trophoblast apoptosis and enhanced trophoblast Fas expression. As a complement to our in vivo study, we demonstrated that cytokine-induced trophoblast apoptosis is mediated in part by the FasL/Fas pathway, suggesting that cytokines promote sensitivity to Fas-mediated apoptosis. These mechanisms may be important in perpetuating inflammation in the placental microenvironment and may contribute to the pathogenesis of chorioamnionitis.

Adult↗

PubMed2004

Increased rates of chorioamnionitis with extra-amniotic saline infusion method of labor induction.

OBJECTIVE: Extra-amniotic saline infusion has been shown to be equal to or more efficacious than misoprostol, laminaria, dinoprostone, and prostaglandin estradiol for cervical ripening and labor induction. Because of the introduction of a foreign body into the uterus, extra-amniotic saline infusion may potentially cause increased rates of chorioamnionitis. This study examines the risk of chorioamnionitis with extra-amniotic saline infusion compared with other methods of induction and spontaneous labor. METHODS: A retrospective analysis was performed based on deliveries at Bellevue Hospital Center, a tertiary-care facility, from August 2000 to December 2002. Three groups were identified: extra-amniotic saline infusion, other methods of induction, and spontaneous labor. Differences in chorioamnionitis rates were analyzed by using analysis of variance and multivariable logistic regression as appropriate. RESULTS: There were 625 charts evaluated: 171 extra-amniotic saline infusion, 190 other, and 264 with spontaneous labor. The rates of chorioamnionitis were 26.9%, 17.9%, and 13.3%, respectively. After adjusting for confounding variables, such as instrumentation, length of rupture, and number of exams, subjects who were induced with extra-amniotic saline infusion were significantly more likely to develop chorioamnionitis (relative risk = 2.2; 95% confidence interval 1.4, 4.0; P =.006). CONCLUSION: Extra-amniotic saline infusion may be associated with a greater risk of chorioamnionitis when compared with other methods of labor induction. Given the increased risk of chorioamnionitis associated with extra-amniotic saline infusion, its use should be in the context of a careful assessment of the risks and benefits of various methods of labor induction. LEVEL OF EVIDENCE: II-2

Adult↗

PubMed1997

Value of the maternal interleukin 6 level for determination of histologic chorioamnionitis in preterm delivery.

The present study examined whether maternal serum cytokine levels are useful for the diagnosis of histologic chorioamnionitis. The blood samples of 29 women who delivered preterm between 22 and 34 weeks of gestation were collected at delivery, and placentas were histopathologically examined for chorioamnionitis. The interleukin (IL) 6 titer was higher in 18 mothers with histologic chorioamnionitis (median 12.0 pg/ml, range 4.9-63.5 pg/ml) than that in 11 mothers without histologic chorioamnionitis (median 3.5 pg/ml, range 1.7-14.9 pg/ml; p < 0.0001). The C-reactive protein (CRP) titer also differed significantly between these two groups (chorioamnionitis group: median 5.2 mg/dl, range 0.1-12.3 mg/dl; no chorioamnionitis group: median 0.2 mg/dl, range 0.1-0.5 mg/dl; p = 0.0001). The IL-6 titer showed better clinical diagnostic indices and a higher odds ratio (9.78, 95% confidence interval 1.50-63.82) than did CRP (3.26, 95% confidence interval 1.22-8.67). The levels of IL-8, monocyte chemotactic and activating factor, and soluble IL-6 receptor did not differ between the two groups. These data suggest that the level of maternal serum IL-6 is more useful than other markers, including CRP, for the identification of women at risk of impending preterm labor with histologic chorioamnionitis.

Adult↗

PubMed1996

Interleukin-6 expression in cord blood of patients with clinical chorioamnionitis.

The objective of this study was to define whether IL-6 is an early marker of infection in the newborn. To correlate the occurrence of clinical chorioamnionitis with the levels of IL-6 expression in neonates, IL-6 was measured in cord plasma by ELISA and in mononuclear cells by reverse transcriptase-PCR before and after mitogenic stimulation. Eight neonates were included in each of the following four groups: elective cesarean section, uncomplicated normal spontaneous vaginal delivery, delivery after prolonged rupture of amniotic membranes with no evidence of chorioamnionitis, and delivery with evidence of chorioamnionitis. All 32 neonates were clinically well after delivery, and all 16 babies with prolonged rupture of membranes or clinical chorioamnionitis had negative blood cultures. Elevated IL-6 levels were found only in neonates born to mothers with chorioamnionitis (119.7 +/- 33.5 pg/mL versus 2.71 +/- 0.59 pg/mL, p < 0.005). Mononuclear cells from five of these neonates expressed no IL-6 mRNA in vivo despite elevated levels of IL-6 in their cord plasma. Cord blood mononuclear cells from healthy term babies were capable of synthesizing IL-6 in vitro in response to stimulation with bacterial lipopolysaccharide. These results suggest that IL-6 levels in cord plasma increased with clinical chorioamnionitis, despite the lack of evidence of infection in the neonates. Therefore, we conclude that, although a high level of IL-6 may be a good marker of chorioamnionitis, it may not be a specific marker of infection in the newborn.

Chorioamnionitis↗

PubMed2002

Hemodynamic disturbances in premature infants born after chorioamnionitis: association with cord blood cytokine concentrations.

Chorioamnionitis and elevated cord blood inflammatory cytokine concentrations are associated with detectable disturbances of systemic and cerebral hemodynamics in premature newborns. Fifty-five infants (25-31 wk gestation) were enrolled. Chorioamnionitis was defined by placental histology. IL-6, IL-1beta, and tumor necrosis factor-alpha were quantified by ELISA. Blood pressure, heart rate, cardiac output, stroke volume, fractional shortening, and middle cerebral artery blood flow velocities were measured at 3 +/- 1 h after birth. Chorioamnionitis was evident in 22 placentas and was associated with increased IL-6 (p < 0.001), IL-1beta (p = 0.035), and heart rate (p = 0.027); and with decreased mean and diastolic blood pressure (p = 0.026 and p = 0.019, respectively). IL-6 concentration correlated inversely with systolic, mean, and diastolic blood pressures. Right ventricular cardiac output was elevated (p = 0.028) in infants with fetal vessel inflammation. Maternal temperature >or=38.0 degrees C and newborn immature-to-total white blood cell ratio >or=0.4 were associated with significant decreases in left ventricular fractional shortening (p = 0.001 and p = 0.005, respectively). Neither chorioamnionitis nor elevated cytokine concentrations were associated with changes in middle cerebral artery Doppler blood flow velocities. Chorioamnionitis and elevated cord blood IL-6 concentrations are associated with decreased blood pressure in premature newborns. Inflammation of the fetal vessels and nonspecific indicators of infection are associated with disturbances in cardiac function. Infants with chorioamnionitis and elevated cytokine concentrations do not manifest changes in cerebral Doppler indices within the first few postnatal hours. We speculate that cytokine-associated systemic hemodynamic disturbances in premature infants born after chorioamnionitis predispose such infants to perinatal brain injury.

Biomarkers↗

PubMed2004

Activation of umbilical cord endothelial cells and fetal inflammatory response in preterm infants with chorioamnionitis and funisitis.

Chorioamnionitis and funisitis are associated with preterm labor and postnatal morbidity. Activation of endothelium resulting in up-regulation of adhesion molecules seems to be a key mechanism in development of organ damage. We investigated whether chorioamnionitis with or without funisitis in preterm infants induced expression and shedding of adhesion molecules in the umbilical cord and resulted in increased concentrations of E-selectin, intercellular adhesion molecule (ICAM)-1, IL-1beta, IL-6, and IL-8 in the cord blood. Data were obtained by using immunohistochemistry and ELISA. Thirty-two preterm infants were divided into three groups according to histology: chorioamnionitis with funisitis, chorioamnionitis without funisitis, and controls without signs of inflammation. ICAM-1 expression on arterial endothelium was higher with funisitis compared with chorioamnionitis alone or with the control group. Similar results for ICAM-1 expression were found in venous endothelium, vascular walls, Wharton's jelly, and amnion epithelium. Endothelial E-selectin and vascular cell adhesion molecule (VCAM)-1 expression was only induced significantly with funisitis. Serum-concentrations of soluble ICAM-1 were higher with funisitis compared with chorioamnionitis alone or control group. Similarly, concentrations of soluble E-selectin, IL-1beta, IL-6, and IL-8 were increased exclusively with funisitis. In conclusion, only chorioamnionitis with funisitis was associated with systemic inflammation and endothelial activation with up-regulation and shedding of umbilical cord adhesion molecules. We speculate that this activation of endothelium may not be limited to the umbilical cord but may also involve other organs resulting in neonatal morbidity. This underlines the importance of funisitis as a risk factor for adverse outcome.

Cell Adhesion↗

PubMed2002

Histologic chorioamnionitis and umbilical serum levels of pro-inflammatory cytokines and cytokine inhibitors.

OBJECTIVE: To study 1. whether leucocyte infiltration in placenta tissues is associated with elevated umbilical serum levels of inflammatory mediators, and 2. whether leucocyte infiltration in the presence of neonatal disease is associated with additional increase in mediator levels. SETTING: University hospital. POPULATION: Two groups of women with either normal delivery (n = 82) or delivery complicated by prolonged rupture of the membranes, clinical signs of intrauterine infection or preterm labour (n = 139). METHODS: Umbilical cord blood and placenta tissues were collected after delivery. Placentas were classified as non-inflamed (i.e. without leucocyte infiltration, n = 74), or as mild (n = 84), or severe chorioamnionitis (n = 63). Mediator levels were compared between groups. RESULTS: Severe chorioamnionitis was associated with elevated levels of tumour necrosis factor (TNF)alpha, interleukin (IL)-1beta, IL-6, IL-8, soluble TNF receptor p55 and p75, IL-1 receptor antagonist (IL-IRA), and C-reactive protein compared with non-inflamed placentas (all P < 0.05). No differences were found between mild chorioamnionitis and placentas without infiltration. In all, 49 babies suffered from various perinatal diseases, such as clinical sepsis, respiratory distress and asphyxia, and 172 were healthy. Severe chorioamnionitis with subsequent neonatal disease (n = 23) had higher levels of all mediators, except IL-1beta and C-reactive protein, than severe chorioamnionitis without neonatal disease (n = 40, all P < 0.01), but severe chorioamnionitis was also accompanied by a more intense and widely distributed leucocyte infiltration when neonatal disease developed. CONCLUSION: High grade leucocyte infiltration in placenta tissues is associated with elevated levels of TNFalpha, IL-1beta, IL-6, IL-8, p55, p75, IL-IRA and C-reactive protein in umbilical serum. The presence of neonatal disease is associated with advanced chorioamnionitis, and highly elevated levels of both pro- and antiinflammatory mediators in umbilical serum.

Acute Disease↗

PubMed1990

Histologic chorioamnionitis, microbial infection, and prematurity.

The purpose of this study was to relate histologic chorioamnionitis to the isolation of microorganisms from the freshly separated chorioamnion in women who had early preterm delivery (before 35 weeks' gestation) following spontaneous labor. Histologic chorioamnionitis was identified in 51 of 95 study subjects. It was more common in the second trimester (72%) than from 27-34 weeks' gestation (33%) (P less than .001). Culture specimens were obtained for aerobic and anaerobic bacteria, yeasts, mycoplasmas, and Chlamydia. Microorganisms were recovered from 38 subjects; all culture reports were negative in 36. A statistically significant association was demonstrated between histologic chorioamnionitis and positive culture results. If any microorganism was recovered, 68% of the subjects had histologic chorioamnionitis, versus 39% if all cultures were negative. Of cases of histologic chorioamnionitis in the third trimester, 92% were associated with positive cultures, compared with 54% in the second trimester. Our results suggest that histologic chorioamnionitis is not synonymous with infection, especially in the second trimester.

Adolescent↗

PubMed1987

The effect of chorioamnionitis on perinatal outcome in preterm gestation.

Six hundred ninety-eight patients with premature rupture of the membranes between 26 and 34 weeks were managed expectantly without the use of tocolytics or corticosteroids. Of these, 92 (13 per cent) developed chorioamnionitis. Although latency period (defined as the time from rupture of the membranes to the onset of labor) had no correlation with the incidence of chorioamnionitis, the mean latency period was significantly shorter for those gestations complicated by infection. The risk of chorioamnionitis was found to be inversely related to gestational age. The length of labor, once chorioamnionitis was diagnosed, had no correlation with neonatal outcome, but the development of chorioamnionitis led to a statistically significant increase in neonatal mortality, infection rate, incidence of respiratory distress syndrome (RDS), intraventricular hemorrhage (IVH), and five-minute Apgar score less than 7. Maternal endometritis and other complications of infection were increased in the presence of chorioamnionitis, especially in patients delivered by Cesarean section. Useful predictors of early chorioamnionitis were maternal leukocytosis, fetal tachycardia, and elevated maternal C-reactive protein titers.

Chorioamnionitis↗

PubMed1984

Placental microbiology and histology and the pathogenesis of chorioamnionitis.

The present study was undertaken to determine the proportion of cases of chorioamnionitis that was caused by microbiologic agents. Seventy-five placentas were processed to isolate aerobic and anaerobic bacteria and chlamydia. Results were correlated with the presence or absence of histologic and clinical chorioamnionitis. Bacteria were recovered from 72% (18 of 25) of placentas with histologic chorioamnionitis and from nine of 11 cases (82%) of clinical chorioamnionitis, all of which had histologic chorioamnionitis. Bacteria were recovered from only 15% (six of 39) of placentas without histologic chorioamnionitis. Nearly 50% of the bacteria recovered from placentas were anaerobes, often fastidious in their growth requirements. Often two to three such anaerobes were recovered from a placenta. Findings of the present study increase the possibility that bacteria are responsible for most cases of chorioamnionitis.

Chlamydia Infections↗

PubMed1999

Association between a shift in vaginal flora on Papanicolaou smear and acute chorioamnionitis and preterm delivery.

Bacterial vaginosis has been implicated as a cause of acute chorioamnionitis and preterm delivery. This study was designed to determine any association between the detection of bacterial vaginosis on a prenatal Papanicolaou (Pap) smear, defined as a shift in vaginal flora, and the subsequent occurrence of acute chorioamnionitis or preterm labor. A 47-mo retrospective case-control analysis comparing 186 patients with histologically-proven acute chorioamnionitis (cases) and 186 controls was performed. Initial prenatal Pap smears were evaluated for the presence of altered vaginal flora. Pap smears from women with acute chorioamnionitis were more likely to have altered vaginal flora than those without chorioamnionitis (P < 0.01). Preterm delivery was also more common among women with a shift in vaginal flora (P < 0.01). In conclusion, women at risk for chorioamnionitis and/or preterm delivery may be able to be identified by the results of their prenatal Pap smear.

Acute Disease↗

PubMedDate not supplied

Maternal chorioamnionitis and umbilical vein interleukin-6 levels for identifying early neonatal sepsis.

OBJECTIVE: The purpose of this study was to determine whether elevated levels of umbilical vein IL-6 would be a better marker for early neonatal sepsis than the clinical signs of maternal chorioamnionitis. METHODS: Patients delivering preterm because of spontaneous preterm labor or premature rupture of the membranes were evaluated for clinical signs of chorioamnionitis, which was defined as a temperature of > or =100.4 degrees F along with > or =2 of the following: significant maternal tachycardia (> or = 120 bpm), fetal tachycardia (> or =160 bpm), purulent discharge, uterine tenderness, and leukocytosis (WBC > or =18,000 cells/mm3). Umbilical vein blood was assayed for interleukin-6. An elevated interleukin-6 level was determined to be 25 pg/mL. Infants were evaluated for evidence of early neonatal sepsis. The abilities of clinical chorioamnionitis and interleukin-6 levels > or =25 pg/mL to predict early neonatal sepsis were compared. RESULTS: There were 28 patients delivering 14 (50%) neonates with evidence for early neonatal sepsis. The incidence of suspected neonatal sepsis in women with and without clinical chorioamnionitis was 6/10 (60%) vs. 8/18 (44.4%), P = 0.43. Using receiver operator characteristic curves, the best cutoff for interleukin-6 was found to be 25 pg/mL. The compared sensitivity, specificity, and positive and negative predictive values of clinical chorioamnionitis vs. interleukin-6 levels > or =25 pg/mL for predicting early neonatal sepsis were 42.9% vs. 92.9%, 71.4% vs. 92.9%, 60% vs. 92.9%, and 55.6% vs. 92.9%, respectively. CONCLUSIONS: Elevated umbilical vein levels of interleukin-6 predict those preterm infants with early sepsis better than the presence of clinical chorioamnionitis.

Chorioamnionitis↗

PubMed2001

Chorioamnionitis, not epidural analgesia, is associated with maternal fever during labour.

PURPOSE: Maternal fever is associated with chorioamnionitis and has been linked to labour epidural analgesia (LEA). The purpose of this study was to determine possible associations between LEA and chorioamnionitis, maternal fever, operative delivery rate, and neonatal outcome. METHODS: Data from 14,073 patients were entered into a database over a two-year period. From this database, 62 nulliparous parturients with clinical chorioamnionitis (amnionitis), but without LEA were identified (Group I). Two other groups who received LEA were matched for parity and gestation: Group II - LEA with concomitant amnionitis (n=50) and, Group III - LEA without concomitant amnionitis (n=201). The diagnosis of chorioamnionitis was confirmed by histologic examination. Results are expressed as mean +/- SD and analyzed at P <0.05 using ANOVA or Chi-square. RESULTS: No differences were noted among the groups in the operative delivery rate or Apgar scores at five minutes. The percentage of patients with maternal fever during labour (38.0 degrees C) with amnionitis was significantly less in Group III compared to the other groups (100% in both Groups I and II vs 1.0% in Group III; P=0.000). Likewise, Group III had a lower percentage of neonates with Apgar scores <7 at one minute (35.5% in Group I, 20.0% in Group II, 17.4% in Group III; P=0.010). The percentage of histologic chorioamnionitis was significantly higher in both amnionitis groups compared to Group III (67.7% in Group I, 56.0% in Group II, 4.0% in Group III; P=0.000). CONCLUSION: LEA without chorioamnionitis is not associated with maternal fever (38.0 degrees C), increased operative delivery rates or low Apgar scores.

Adult↗

PubMed2004

Chorioamnionitis risk and neonatal outcome in preterm premature rupture of membranes.

OBJECTIVE: The objective of this study was to compare the neonatal outcome in patients with preterm premature rupture of membranes with and without clinical chorioamnionitis. STUDY DESIGN: This is a retrospective study that included 254 pregnant women with preterm rupture of membranes. The study group was divided according to the presence or absence of clinical chorioamnionitis defined as the presence of two or more of the following criteria: maternal temperature >38 degrees C on two or more occasions > or =1 h apart, maternal tachycardia (> or =120 beats/min), uterine tenderness, foul smelling amniotic fluid, maternal leukocytosis > or =20,000 mm(-3) with bands and positive C reactive protein. Also the study population was divided according to the use of tocolysis. Exclusion criteria included multiple pregnancy, fetal congenital anomalies, diabetes mellitus and severe preeclampsia. Amniotic fluid was collected from the cervix or from the transabdominal amniocentesis. Antibiotics and tocolysis were used according to the hospital protocols. Parametric and nonparametric statistics were used for comparisons. RESULTS: There were no significant differences in birth weight, Apgar scores at 1 and 5 min, rates of respiratory distress syndrome, intraventricular hemorrhage and necrotizing enterocolitis between patients with and without clinical chorioamnionitis or between women who received tocolysis and the ones that did not receive tocolysis. In cases of clinical chorioamnionitis and when tocolysis was used the neonates stayed longer in the neonatal intensive care unit (NICU). CONCLUSION: Patients with preterm premature rupture of membranes and clinical chorioamnionitis have similar neonatal outcomes than the ones without clinical chorioamnionitis.

Adolescent↗

PubMed2004

Early postnatal skin colour changes in term newborns with subclinical histological chorioamnionitis.

UNLABELLED: Chorioamnionitis, a known risk factor for fetal and neonatal morbidity both in preterm and term newborns, is often subclinical. Earlier observations have linked skin colourimetry to neonatal illness severity and adverse neonatal outcome. Here, we tested the hypothesis that subclinical histological chorioamnionitis is associated with early postnatal skin colour changes in term newborns. Skin colourimetry on ten body sites (forehead, cheek, forearm, palm, upper chest, abdomen, back, buttock, leg, and sole) was examined in 45 term infants with subclinical histological chorioamnionitis and 45 sex- and gestational age-matched controls, using a tristimulus portable colourimeter at 1, 5 and 10 min after birth. Infants with subclinical histological chorioamnionitis showed statistically significant early postnatal skin colourimetric differences, in nine and seven out of the ten body sites examined as compared to control newborns at 1 min (P< or =0.0092), 5 min (P< or =0.0081) and 10 min (P< or =0.0056) from birth, respectively. Skin colourimetry changes were associated with lower 1 min Apgar scores (P<0.0001), cord blood pH (P<0.0001), PaO2 (P<0.0001), and base excess (P<0.0001) values, together with higher cord blood PaCO2 (P=0.0001), NICU admissions (P=0.00076), endotracheal intubation in the delivery room (P=0.012), Neonatal Acute Physiology-Perinatal Extension (P<0.0001) and Neonatal Therapeutic Intervention Scoring System (P<0.0001) scores than the chorioamnionitis-negative infants. CONCLUSION: These findings, compatible with early peripheral microcirculatory changes, indicate skin vasoconstriction as an early neonatal manifestation of subclinical chorioamnionitis.

Case-Control Studies↗