Division of Neonatology, Department of Paediatrics, Willem-Alexander Children's Hospital, Leiden University Medical Centre, P.O. Box 9600, 2300 RC, Leiden, The Netherlands.
Department of Pathology, Leiden University Medical Centre, Leiden, The Netherlands.
Eur J Pediatr. 2024 Dec;183(12):5497-5507. doi: 10.1007/s00431-024-05815-w. Epub 2024 Oct 25.
Antenatal inflammation in the form of chorioamnionitis (fetal membranes; HCA) and funisitis (umbilical vessels; FUN) is a major risk factor for preterm birth. Exposure to HCA + FUN affects infants by releasing mediators that may suppress respiratory drive. While the association between clinical chorioamnionitis (CCA) and (depressed) spontaneous breathing has been described, we have investigated the association between breathing and HCA + FUN. Infants born < 30 weeks' gestation with available placental pathology assessments were included. Infants were compared at multiple levels: infants with vs without HCA + FUN (comparison 1) and infants with subclinical HCA + FUN vs infants without any chorioamnionitis (comparison 2). The primary outcome was breathing effort, defined as minute volume (MV) of spontaneous breathing in the first 5 min after birth. We also assessed tidal volume (Vt), respiratory rate (RR), heart rate (HR), oxygen saturation (SpO) and oxygen requirement (FiO). Regression analyses were performed to control for confounding factors. One hundred eighty-six infants were included (n = 75 infants with HCA + FUN vs. n = 111 infants without HCA + FUN). Comparison 1: Infants with HCA + FUN had lower gestational ages 26 (25-28; median (IQR) and lower birthweights (mean ± SD; 943 ± 264) compared to infants without HCA + FUN (28 (27-29) weeks, p < 0.001 and 1023 ± 270 g, p = 0.049). Comparison 2: Subclinical HCA + FUN was diagnosed in 46/75 HCA + FUN infants. Infants with subclinical HCA + FUN had lower gestational ages (26 (25-28) vs. 28 (27-29) weeks, p < 0.001) without significant differences for birthweights (987 ± 248 vs. 1027 ± 267 g, p = 0.389) compared to infants without any chorioamnionitis (n = 102 infants). After adjustment, HCA + FUN was associated with lower MV (p = 0.025), but subclinical HCA + FUN was not (p = 0.226). HCA + FUN and subclinical HCA + FUN were associated with lower Vt (p = 0.003; p = 0.014), SpO at 5 min (p = 0.021; 0.036) and SpO/FiO ratio (p = 0.028; p = 0.040).
HCA + FUN and subclinical HCA + FUN are associated with reduced oxygenation and parameters that reflect breathing effort in premature infants at birth.
• Acute antenatal inflammation, in the form of chorioamnionitis (fetal membranes) and funisitis (umbilical vessels), affects a large proportion of premature infants. • Clinical chorioamnionitis is associated with reduced breathing effort and oxygenation in premature infants at birth.
• Histological and subclinical chorioamnionitis and funisitis are associated with reduced breathing effort parameters and oxygenation in premature infants at birth.
以绒毛膜羊膜炎（胎儿膜；HCA）和脐带炎（脐带血管；FUN）形式出现的产前炎症是早产的主要危险因素。暴露于 HCA+FUN 会通过释放可能抑制呼吸驱动的介质来影响婴儿。虽然已经描述了临床绒毛膜羊膜炎（CCA）与（抑制）自发性呼吸之间的关联，但我们已经研究了呼吸与 HCA+FUN 之间的关联。纳入了胎龄<30 周且胎盘病理评估结果可用的婴儿。在多个水平上对婴儿进行了比较：有 HCA+FUN 的婴儿与无 HCA+FUN 的婴儿（比较 1）和有亚临床 HCA+FUN 的婴儿与无任何绒毛膜羊膜炎的婴儿（比较 2）。主要结局是呼吸努力，定义为出生后 5 分钟内自发性呼吸的分钟通气量（MV）。我们还评估了潮气量（Vt）、呼吸频率（RR）、心率（HR）、血氧饱和度（SpO）和氧需求（FiO）。进行了回归分析以控制混杂因素。纳入了 186 名婴儿（n=75 名 HCA+FUN 婴儿与 n=111 名无 HCA+FUN 婴儿）。比较 1：与无 HCA+FUN 的婴儿相比，有 HCA+FUN 的婴儿胎龄更小（26（25-28）中位数（IQR）和出生体重更轻（均值±标准差；943±264）比无 HCA+FUN 的婴儿（28（27-29）周，p<0.001 和 1023±270 g，p=0.049）。比较 2：在 75 名 HCA+FUN 婴儿中诊断出 46 例亚临床 HCA+FUN。亚临床 HCA+FUN 婴儿的胎龄更小（26（25-28）与 28（27-29）周，p<0.001），但出生体重无显著差异（987±248 与 1027±267 g，p=0.389）与无任何绒毛膜羊膜炎的婴儿（n=102 名婴儿）相比。调整后，HCA+FUN 与 MV 降低相关（p=0.025），但亚临床 HCA+FUN 无相关性（p=0.226）。HCA+FUN 和亚临床 HCA+FUN 与 5 分钟时的 Vt 降低相关（p=0.003；p=0.014）、SpO 降低相关（p=0.021；p=0.036）和 SpO/FiO 比值降低相关（p=0.028；p=0.040）。
HCA+FUN 和亚临床 HCA+FUN 与早产婴儿出生时的氧合和反映呼吸努力的参数降低有关。
• 以绒毛膜羊膜炎（胎儿膜）和脐带炎（脐带血管）形式出现的急性产前炎症影响了很大一部分早产儿。• 临床绒毛膜羊膜炎与早产婴儿出生时呼吸努力和氧合降低有关。
• 组织学和亚临床绒毛膜羊膜炎和脐带炎与早产婴儿出生时的呼吸努力参数和氧合降低有关。
