Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul 110-744, Republic of Korea.
Placenta. 2011 Mar;32(3):235-40. doi: 10.1016/j.placenta.2010.11.006. Epub 2011 Jan 8.
Fetal lung maturation and respiratory outcomes are influenced by the exposure to intrauterine inflammation. Funisitis is considered as the histologic hallmark of fetal inflammatory response. This study was performed to determine if there is a difference in the rate of neonatal respiratory distress syndrome (RDS) according to the presence or absence of funisitis in preterm gestations.
The relationship between the presence of funisitis and the development of neonatal RDS was examined in 301 consecutive singleton preterm births (24-32 weeks' gestation). Cases without placental histological examination and those with major congenital anomalies were excluded. Funisitis was diagnosed in the presence of neutrophil infiltration into the umbilical vessel walls or Wharton's jelly on the placental histological examination.
Funisitis was diagnosed in 25% and RDS was diagnosed in 46% of cases. The rate of RDS in babies with funisitis was lower than in those without funisitis (28.4% vs. 51.1%, p = 0.001). Logistic regression analysis demonstrated that the presence of funisitis was associated with a decreased risk for RDS after adjusting for confounding variables (Odds ratio = 0.44, 95% CI 0.22-0.90). The downward trend of the frequency of RDS was related to the presence of histologic chorioamnionitis and funisitis (p < 0.001).
The presence of funisitis is associated with a decreased risk for the development of neonatal RDS in preterm gestations. Furthermore, this observation suggests that the fetal involvement of placental inflammation may be beneficial to the maturation of the fetal lung.
胎儿肺成熟和呼吸结局受宫内炎症暴露的影响。脐炎被认为是胎儿炎症反应的组织学标志。本研究旨在确定在早产妊娠中，是否存在因脐炎的存在与否而导致新生儿呼吸窘迫综合征（RDS）发生率的差异。
在 301 例连续的单胎早产（24-32 周妊娠）中，研究了脐炎的存在与新生儿 RDS 发生的关系。排除了无胎盘组织学检查和存在重大先天性畸形的病例。在胎盘组织学检查中，如果有中性粒细胞浸润脐血管壁或华通氏胶，即可诊断为脐炎。
25%的病例诊断为脐炎，46%的病例诊断为 RDS。有脐炎的婴儿中 RDS 的发生率低于无脐炎的婴儿（28.4%比 51.1%，p=0.001）。Logistic 回归分析表明，在校正混杂变量后，脐炎的存在与 RDS 的发生风险降低相关（优势比=0.44，95%可信区间 0.22-0.90）。RDS 频率的下降趋势与组织学绒毛膜羊膜炎和脐炎的存在有关（p<0.001）。
在早产妊娠中，脐炎的存在与新生儿 RDS 的发生风险降低相关。此外，这一观察结果表明，胎盘炎症中胎儿的参与可能有利于胎儿肺的成熟。
