Thomas W, Speer C P
Universitäts-Kinderklinik, Würzburg.
Z Geburtshilfe Neonatol. 2012 Aug;216(4):173-6. doi: 10.1055/s-0032-1321835. Epub 2012 Aug 27.
Infections in utero and chorioamnionitis are major risk factors for spontaneous, very early premature birth. Thus chorioamnionitis contributes significantly to prematurity-associated morbidity and mortality. Evidence for a gestation-independent effect of chorioamnionitis on the outcome of very low birth weight infants is much more difficult to obtain as most of the studies addressing this issue lack a normal "control group", as prematurity is mostly associated with some kind of prenatal pathology with a potential influence on neonatal outcome. Moreover, major advances in perinatal and neonatal care for this high-risk group have mitigated the impact of chorioamnionitis on morbidity and mortality of very low birth weight infants. Histological chorioamnionitis is associated with a lower incidence and severity of respiratory distress syndrome. However, short-term maturational effects on the lung are associated with a higher susceptibility for postnatal noxious events, such as mechanical ventilation, thus contributing to the risk of bronchopulmonary dysplasia. Data regarding the importance of chorioamnionitis for brain damage of the very premature infant are inconsistent although meta-analyses have shown an increased risk of cystic periventricular leukomalacia and cerebral palsy after exposure to inflammation in utero. Very recent epidemiological studies suggest a role of chorioamnionitis in the aetiology and pathogenesis of retinopathy of prematurity.
子宫内感染和绒毛膜羊膜炎是自发性极早早产的主要危险因素。因此，绒毛膜羊膜炎是早产相关发病率和死亡率的重要促成因素。由于大多数针对这一问题的研究缺乏正常的“对照组”，因为早产大多与某种可能影响新生儿结局的产前病理状况相关，所以要获得绒毛膜羊膜炎对极低出生体重儿结局的非妊娠依赖性影响的证据要困难得多。此外，针对这一高危群体的围产期和新生儿护理方面的重大进展减轻了绒毛膜羊膜炎对极低出生体重儿发病率和死亡率的影响。组织学绒毛膜羊膜炎与呼吸窘迫综合征的较低发病率和严重程度相关。然而，对肺的短期成熟影响与出生后有害事件（如机械通气）的较高易感性相关，从而增加了支气管肺发育不良的风险。尽管荟萃分析显示宫内暴露于炎症后脑室周围白质软化和脑瘫的风险增加，但关于绒毛膜羊膜炎对极早早产儿脑损伤重要性的数据并不一致。最近的流行病学研究表明绒毛膜羊膜炎在早产儿视网膜病变的病因学和发病机制中起作用。
