Obstetrical, Perinatal and Pediatric Epidemiology Research Team, Center for Epidemiology and Statistics Sorbonne Paris Cité, INSERM U1153, Paris, France; Department of Fetal Medicine, Hôpital Armand Trousseau, Assistance Publique-Hôpitaux de Paris, Sorbonne University, Paris, France.
Obstetrical, Perinatal and Pediatric Epidemiology Research Team, Center for Epidemiology and Statistics Sorbonne Paris Cité, INSERM U1153, Paris, France; EPIUnit-Institute of Public Health, University of Porto, Porto, Portugal.
J Pediatr. 2020 Jul;222:71-78.e6. doi: 10.1016/j.jpeds.2020.03.021.
To assess whether chorioamnionitis is associated with cerebral palsy (CP) or death at 2 years' corrected age in infants born before 32 weeks of gestation after spontaneous birth.
EPIPAGE-2 is a national, prospective, population-based cohort study of children born preterm in France in 2011; recruitment periods varied by gestational age. This analysis includes infants born alive after preterm labor or preterm premature rupture of membranes from 24 to 31 weeks of gestation. We compared the outcomes of CP, death at 2 years' corrected age, and "CP or death at age 2" according to the presence of either clinical chorioamnionitis or histologic chorioamnionitis. All percentages were weighted by the duration of the recruitment period.
Among 2252 infants born alive spontaneously before 32 weeks of gestation, 116 (5.2%) were exposed to clinical chorioamnionitis. Among 1470 with placental examination data available, 639 (43.5%) had histologic chorioamnionitis. In total, 346 infants died before 2 years and 1586 (83.2% of the survivors) were evaluated for CP at age 2 years. CP rates were 11.1% with and 5.0% without clinical chorioamnionitis (P = .03) and 6.1% with and 5.3% without histologic chorioamnionitis (P = .49). After adjustment for confounding factors, CP risk rose with clinical chorioamnionitis (aOR 2.13, 95% CI 1.12-4.05) but not histologic chorioamnionitis (aOR 1.21, 95% 0.75-1.93). Neither form was associated with the composite outcome "CP or death at age 2."
Among infants very preterm born spontaneously, the risk of CP at a corrected age of 2 years was associated with exposure to clinical chorioamnionitis but not histologic chorioamnionitis.
评估自发性早产分娩且胎龄＜32 周的婴儿是否存在绒毛膜羊膜炎与校正 2 岁时脑瘫（CP）或死亡的关系。
EPIPAGE-2 是一项在法国开展的、针对 2011 年早产婴儿的全国性、前瞻性、基于人群的队列研究；根据胎龄不同，招募时间也有所不同。本分析纳入了胎龄 24-31 周、自发性早产分娩且存活的婴儿。我们比较了存在临床绒毛膜羊膜炎或组织学绒毛膜羊膜炎的婴儿的 CP、校正 2 岁时死亡以及“CP 或 2 岁时死亡”结局的差异。所有百分比均根据招募期的长短进行加权。
在 2252 例自发性早产且胎龄＜32 周的存活婴儿中，116 例（5.2%）存在临床绒毛膜羊膜炎。在 1470 例有胎盘检查数据的婴儿中，639 例（43.5%）存在组织学绒毛膜羊膜炎。共有 346 例婴儿在 2 岁前死亡，1586 例（幸存者的 83.2%）在 2 岁时评估 CP。有临床绒毛膜羊膜炎的 CP 发生率为 11.1%，无临床绒毛膜羊膜炎的 CP 发生率为 5.0%（P=0.03）；有组织学绒毛膜羊膜炎的 CP 发生率为 6.1%，无组织学绒毛膜羊膜炎的 CP 发生率为 5.3%（P=0.49）。调整混杂因素后，临床绒毛膜羊膜炎与 CP 风险增加相关（aOR 2.13，95%CI 1.12-4.05），而组织学绒毛膜羊膜炎则无此相关性（aOR 1.21，95%CI 0.75-1.93）。这两种绒毛膜羊膜炎均与“CP 或 2 岁时死亡”的复合结局无关。
在自发性早产分娩且胎龄非常小的婴儿中，校正 2 岁时 CP 的风险与临床绒毛膜羊膜炎有关，而与组织学绒毛膜羊膜炎无关。
