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绒毛膜羊膜炎对早产儿出生时呼吸驱动力和自主呼吸的影响:叙述性综述。

The influence of chorioamnionitis on respiratory drive and spontaneous breathing of premature infants at birth: a narrative review.

机构信息

Division of Neonatology, Department of Paediatrics, Willem-Alexander Children's Hospital, Leiden University Medical Centre, P.O. Box 9600, 2300 RC, Leiden, Netherlands.

The Ritchie Centre, Hudson Institute of Medical Research, Clayton, VIC, Australia.

出版信息

Eur J Pediatr. 2024 Jun;183(6):2539-2547. doi: 10.1007/s00431-024-05508-4. Epub 2024 Apr 1.

Abstract

Most very premature infants breathe at birth but require respiratory support in order to stimulate and support their breathing. A significant proportion of premature infants are affected by chorioamnionitis, defined as an umbrella term for antenatal inflammation of the foetal membranes and umbilical vessels. Chorioamnionitis produces inflammatory mediators that potentially depress the respiratory drive generated in the brainstem. Such respiratory depression could maintain itself by delaying lung aeration, hampering respiratory support at birth and putting infants at risk of hypoxic injury. This inflammatory-mediated respiratory depression may contribute to an association between chorioamnionitis and increased requirement of neonatal resuscitation in premature infants at birth. This narrative review summarises mechanisms on how respiratory drive and spontaneous breathing could be influenced by chorioamnionitis and provides possible interventions to stimulate spontaneous breathing.  Conclusion: Chorioamnionitis could possibly depress respiratory drive and spontaneous breathing in premature infants at birth. Interventions to stimulate spontaneous breathing could therefore be valuable. What is Known: • A large proportion of premature infants are affected by chorioamnionitis, antenatal inflammation of the foetal membranes and umbilical vessels. What is New: • Premature infants affected by chorioamnionitis might be exposed to higher concentrations of respiratory drive inhibitors which could depress breathing at birth. • Premature infants affected by chorioamnionitis seem to be associated with a higher and more extensive requirement of resuscitation at birth.

摘要

大多数非常早产儿在出生时会自主呼吸,但需要呼吸支持来刺激和辅助他们呼吸。相当一部分早产儿受到绒毛膜羊膜炎的影响,该术语定义为胎儿膜和脐带血管产前炎症的总称。绒毛膜羊膜炎会产生炎症介质,这些介质可能会抑制脑干产生的呼吸驱动力。这种呼吸抑制可能通过延迟肺充气来维持自身,阻碍出生时的呼吸支持,并使婴儿面临缺氧损伤的风险。这种炎症介导的呼吸抑制可能导致绒毛膜羊膜炎与早产儿出生时需要更多新生儿复苏之间存在关联。本综述总结了绒毛膜羊膜炎如何影响呼吸驱动力和自主呼吸的机制,并提供了可能刺激自主呼吸的干预措施。结论:绒毛膜羊膜炎可能会抑制早产儿出生时的呼吸驱动力和自主呼吸。因此,刺激自主呼吸的干预措施可能具有重要价值。已知:大量早产儿受到绒毛膜羊膜炎的影响,即胎儿膜和脐带血管的产前炎症。新发现:受到绒毛膜羊膜炎影响的早产儿可能暴露于更高浓度的呼吸驱动力抑制剂中,这可能会抑制他们在出生时的呼吸。受到绒毛膜羊膜炎影响的早产儿在出生时似乎需要更高水平和更广泛的复苏。

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