Metcalfe Amy, Lisonkova Sarka, Sabr Yasser, Stritzke Amelie, Joseph K S
Department of Obstetrics and Gynecology, University of Calgary, Foothills Medical Centre, 4th Floor North Tower, 1403 29th St NW, Calgary, AB, T2N 2T9, Canada.
Department of Obstetrics and Gynecology, University of British Columbia, Vancouver, BC, Canada.
BMC Pediatr. 2017 May 17;17(1):128. doi: 10.1186/s12887-017-0878-9.
There are conflicting results in the literature on the impact of chorioamnionitis on neonatal respiratory morbidities. However, most studies are based on small clinical samples and fail to account for the competing risk of perinatal death. This study aimed to determine whether chorioamnionitis affects the incidence of respiratory distress syndrome (RDS) and bronchopulmonary dysplasia (BPD) after accounting for the increased risk of death.
Retrospective cohort study using linked birth and infant death registration and hospitalization records from Washington State between 2002 and 2011 (n = 763,671 singleton infants and n = 56,537 singleton preterm infants). Logistic regression models based on the traditional and fetuses-at-risk approaches were used to model two composite outcomes namely RDS and perinatal death and BPD and perinatal death. Confounders adjusted for in the models included maternal age, race, diabetes, hypertension, antenatal corticosteroids, mode of delivery and infant sex.
While models using the traditional approach found a significant association only between chorioamnionitis and composite BPD and perinatal death (OR = 1.23, 95% CI: 1.01-1.50); using the fetuses-at-risk approach, there was a significant association between chorioamnionitis and both composite outcomes (RDS and perinatal death OR = 2.74, 2.50-3.01; BPD and perinatal death OR = 5.18, 95% CI: 4.39-6.11).
The fetuses-at-risk approach models the causal impact of chorioamnionitis on the development of the fetal lung and shows an increased risk of RDS, BPD and perinatal death associated with such maternal infection.
关于绒毛膜羊膜炎对新生儿呼吸系统疾病的影响，文献中的结果相互矛盾。然而，大多数研究基于小临床样本，且未考虑围产期死亡的竞争风险。本研究旨在确定在考虑死亡风险增加的情况下，绒毛膜羊膜炎是否会影响呼吸窘迫综合征（RDS）和支气管肺发育不良（BPD）的发生率。
采用回顾性队列研究，使用2002年至2011年华盛顿州的出生与婴儿死亡登记及住院记录相链接的数据（n = 763,671名单胎婴儿和n = 56,537名单胎早产婴儿）。基于传统方法和风险胎儿方法的逻辑回归模型用于模拟两个复合结局，即RDS与围产期死亡以及BPD与围产期死亡。模型中调整的混杂因素包括产妇年龄、种族、糖尿病、高血压、产前使用糖皮质激素、分娩方式和婴儿性别。
使用传统方法的模型仅发现绒毛膜羊膜炎与复合BPD及围产期死亡之间存在显著关联（OR = 1.23，95%CI：1.01 - 1.50）；而使用风险胎儿方法时，绒毛膜羊膜炎与两个复合结局均存在显著关联（RDS与围产期死亡OR = 2.74，2.50 - 3.01；BPD与围产期死亡OR = 5.18，95%CI：4.39 - 6.11）。
风险胎儿方法模拟了绒毛膜羊膜炎对胎儿肺发育的因果影响，并显示出这种母体感染与RDS、BPD及围产期死亡风险增加相关。
