Department of Pediatrics, Kitasato University, Sagamihara, Kanagawa, Japan.
Division of Neonatal Intensive Care Medicine, Research and Development Center for New Medical Frontiers, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan.
Am J Perinatol. 2024 May;41(S 01):e2383-e2389. doi: 10.1055/a-2113-4332. Epub 2023 Jun 20.
Terminating pregnancy appropriately before the intrauterine infection has progressed may have an improved prognosis for preterm infants. We evaluate how the combination of histological chorioamnionitis (hCAM) and clinical chorioamnionitis (cCAM) affects the short-term prognosis of infants.
This retrospective multicenter cohort study based on the Neonatal Research Network of Japan included extremely preterm infants born weighing <1,500 g between 2008 and 2018. Demographic characteristics, morbidity, and mortality were compared between the cCAM(-)hCAM(+) and cCAM(+)hCAM(+) groups.
We included 16,304 infants. The progression to cCAM in infants with hCAM was correlated with the increase in home oxygen therapy (HOT) (adjusted odds ratio [aOR], 1.27; 95% confidence interval [CI], 1.11-1.44) and persistent pulmonary hypertension of the newborn (PPHN) (1.20, 1.04-1.38). Furthermore, increased progression of the hCAM stage in infants with cCAM correlated with an increase in bronchopulmonary dysplasia (BPD; 1.05, 1.01-1.11), HOT (1.10, 1.02-1.18), and PPHN (1.09, 1.01-1.18). However, it had a negative impact on hemodynamically significant patent ductus arteriosus (hsPDA; 0.87, 0.83-0.92) and death before discharge from the neonatal intensive care unit (NICU; 0.88, 0.81-0.96).
Progression to cCAM in infants with hCAM positively correlated with HOT and PPHN. Progression of hCAM staging in infants with cCAM further increases the prevalence of BPD and the need for HOT and PPHN while reducing the prevalence of hsPDA and death before discharge from the NICU. The effects of the progressive hCAM stage in infants with cCAM vary from positive to negative by disease.
· Retrospective multicenter cohort study based on the Neonatal Research Network of Japan.. · Clinical and histological chorioamnionitis increases the prevalence of BPD, HOT, and PPHN.. · Progression of histological chorioamnionitis in infants reduces the prevalence of hsPDA and death..
在宫内感染进展之前适当终止妊娠，可能会改善早产儿的预后。我们评估组织学绒毛膜羊膜炎（hCAM）和临床绒毛膜羊膜炎（cCAM）的联合作用如何影响婴儿的短期预后。
这项基于日本新生儿研究网络的回顾性多中心队列研究纳入了 2008 年至 2018 年间出生体重<1500g 的极早产儿。比较了 cCAM（-）hCAM（+）组和 cCAM（+）hCAM（+）组之间的人口统计学特征、发病率和死亡率。
我们纳入了 16304 名婴儿。hCAM 患儿进展为 cCAM 与家庭氧疗（HOT）的增加（调整优势比[aOR]，1.27；95%置信区间[CI]，1.11-1.44）和持续性肺动脉高压新生儿（PPHN）（1.20，1.04-1.38）相关。此外，cCAM 患儿 hCAM 分期的进展与支气管肺发育不良（BPD；1.05，1.01-1.11）、HOT（1.10，1.02-1.18）和 PPHN（1.09，1.01-1.18）的增加相关。然而，它对血液动力学显著的动脉导管未闭（hsPDA；0.87，0.83-0.92）和从新生儿重症监护病房（NICU）出院前的死亡（0.88，0.81-0.96）有负面影响。
hCAM 患儿进展为 cCAM 与 HOT 和 PPHN 呈正相关。cCAM 患儿 hCAM 分期的进展进一步增加了 BPD 的发生率和 HOT 和 PPHN 的需求，同时降低了 hsPDA 和从 NICU 出院前死亡的发生率。cCAM 患儿 hCAM 分期的进展对疾病的影响由正转负。
· 基于日本新生儿研究网络的回顾性多中心队列研究。· 临床和组织学绒毛膜羊膜炎增加了 BPD、HOT 和 PPHN 的发生率。· hCAM 在婴儿中的进展降低了 hsPDA 和死亡的发生率。
