组织学绒毛膜羊膜炎及其对极低出生体重早产儿呼吸结局的影响。
Histological chorioamnionitis and its impact on respiratory outcome in very-low-birth-weight preterm infants.
机构信息
Department of Pediatrics, Cathay General Hospital, Taipei, Taiwan.
Department of Pediatrics, Cathay General Hospital, Taipei, Taiwan; School of Medicine, Fu Jen Catholic University, New Taipei City, Taiwan; Department of Pediatrics, National Taiwan University Children's Hospital, Taipei, Taiwan.
出版信息
Pediatr Neonatol. 2021 May;62(3):258-264. doi: 10.1016/j.pedneo.2020.11.009. Epub 2021 Jan 20.
BACKGROUND
The role of intrauterine infection in the development of neonatal pulmonary disease is unclear and the impact of histological chorioamnionitis (HCAM) on respiratory outcomes in preterm infants remains controversial. The aim of this study was to explore the association between HCAM and neonatal respiratory outcomes in very-low-birth-weight (VLBW) preterm infants and evaluate the stepwise difference in the stage and severity of HCAM among neonatal respiratory outcomes.
METHODS
We retrospectively enrolled 129 VLBW preterm infants with placenta histopathology examinations in this study. HCAM was subdivided into 3 stages (early, intermediate, and advanced) according to the progression of the maternal inflammatory response. The perinatal characteristics, placental histopathology, and neonatal morbidities, including respiratory outcomes (respiratory distress syndrome (RDS), Wilson-Mikity syndrome (WMS) and bronchopulmonary dysplasia (BPD)), were collected for comparison.
RESULTS
A total of 52.7% (68/129) of the infants had HCAM, including 23 early (stage 1), 30 intermediate (stage 2), and 15 advanced (stage 3) stage. There was no significant difference in the gestational age, birth body weight or mortality rate between the HCAM and non-HCAM groups. Mothers with HCAM had a significantly lower incidence of pre-eclampsia but a higher rate of premature rupture of membrane. They also had higher WBC counts and C-reactive protein levels before delivery. Neonates with HCAM had a lower incidence of RDS but were at a higher risk for developing WMS and BPD. After multivariate analysis adjustment, HCAM was still negatively associated with RDS (aOR = .069, p < .001) but without correlation with BPD. However, neonates with intermediate to advanced-stage HCAM had a higher risk of developing WMS and increased home oxygen usage rate compared to those with early-stage HCAM.
CONCLUSION
HCAM has a protective effect from RDS in preterm neonates. Additionally, VLBW neonates with intermediate to advanced-stage HCAM are at risk for WMS.
背景
宫内感染在新生儿肺部疾病发展中的作用尚不清楚，组织学绒毛膜羊膜炎（HCAM）对早产儿呼吸结局的影响仍存在争议。本研究旨在探讨 HCAM 与极低出生体重（VLBW）早产儿呼吸结局的关系，并评估 HCAM 在新生儿呼吸结局中的分期和严重程度的差异。
方法
本研究回顾性纳入了 129 例胎盘组织病理学检查的 VLBW 早产儿。根据母体炎症反应的进展，将 HCAM 分为 3 期（早期、中期和晚期）。收集围产期特征、胎盘组织病理学和新生儿并发症，包括呼吸结局（呼吸窘迫综合征（RDS）、Wilson-Mikity 综合征（WMS）和支气管肺发育不良（BPD）），进行比较。
结果
共有 52.7%（68/129）的婴儿存在 HCAM，其中早期（1 期）23 例，中期（2 期）30 例，晚期（3 期）15 例。HCAM 组和非 HCAM 组在胎龄、出生体重或死亡率方面无显著差异。HCAM 组母亲的子痫前期发生率较低，但胎膜早破发生率较高。分娩前白细胞计数和 C 反应蛋白水平也较高。HCAM 组新生儿 RDS 发生率较低，但发生 WMS 和 BPD 的风险较高。多变量分析调整后，HCAM 与 RDS 仍呈负相关（aOR=0.069，p<0.001），但与 BPD 无关。然而，中晚期 HCAM 组新生儿发生 WMS 的风险较高，需要家庭吸氧的比例也较高。
结论
HCAM 对早产儿 RDS 有保护作用。此外，中晚期 HCAM 的 VLBW 早产儿发生 WMS 的风险增加。
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