Perinatology.  2019 Mar;30(1):8-13. 10.14734/PN.2019.30.1.8.

The Relationship between Histological Chorioamnionitis and Bronchopulmonary Dysplasia in Low-Birth Weight Infants: Changes of C-Reactive Protein in Bronchopulmonary Dysplasia

Affiliations
  • 1Department of Pediatrics, Korea University College of Medicine, Seoul, Korea. hongys@korea.ac.kr
  • 2Department of Obstetrics and Gynecology, Korea University College of Medicine, Seoul, Korea.

Abstract


OBJECTIVE
Intrauterine inflammation caused by chorioamnionitis has been related with various perinatal morbidities which increase the risk of bronchopulmonary dysplasia (BPD). C-reactive protein (CRP) is a well known biomarker of inflammation. We aimed to investigate the relationship between histological chorioamnionitis (HCA) and BPD, and also to observe the changes of CRP in BPD.
METHODS
Low-birth-weight infants (LBWIs) admitted to the neonatal intensive care unit between January 2011 and October 2017 were reviewed. Perinatal morbidities associated with BPD including maternal HCA were observed. Also, changes of CRP were analyzed.
RESULTS
A total of 584 LBWIs were analyzed and 168 (28.8%) had HCA and 46 (7.9%) had BPD. The development of BPD was associated with gestational age, birth weight, 1 and 5 minutes Apgar scores, the presence of preterm premature rupture of membrane, prenatal antibiotics, respiratory distress syndrome (RDS), ventilator application, early onset sepsis, necrotizing enterocolitis, intraventricular hemorrhage, retinopathy of prematurity, patent ductus arteriosus and HCA. The multiple logistic regression model for BPD showed that the risk factors of BPD were lower gestational age, lower birth weight, patent ductus arteriosus (PDA). Chorioamnionitis was not a significant risk factor for BPD (aOR, 1.477; 95% CI, 0.376-5.806). Infants with BPD were likely to have higher CRP on day 0 and day 7.
CONCLUSION
Our study suggests that the primary risk factors of BPD in LBWIs are lower gestational age, lower birth weight, RDS, ventilator application and PDA rather than HCA. In infants with BPD, CRP was significantly higher on day 0 and day 7.

Keyword

Chorioamnionitis; Bronchopulmonary dysplasia; C-reactive protein; Inflammation

MeSH Terms

Anti-Bacterial Agents
Birth Weight
Bronchopulmonary Dysplasia*
C-Reactive Protein*
Chorioamnionitis*
Ductus Arteriosus, Patent
Enterocolitis, Necrotizing
Female
Gestational Age
Hemorrhage
Humans
Infant*
Infant, Low Birth Weight
Infant, Newborn
Inflammation
Intensive Care, Neonatal
Logistic Models
Membranes
Pregnancy
Retinopathy of Prematurity
Risk Factors
Rupture
Sepsis
Ventilators, Mechanical
Anti-Bacterial Agents
C-Reactive Protein

Reference

References

1. Speer CP. Inflammation and bronchopulmonary dysplasia: a continuing story. Semin Fetal Neonatal Med. 2006; 11:354–62.
Article
2. Kim CJ, Romero R, Chaemsaithong P, Chaiyasit N, Yoon BH, Kim YM. Acute chorioamnionitis and funisitis: definition, pathologic features, and clinical significance. Am J Obstet Gynecol. 2015; 213(4 Suppl):S29–52.
Article
3. Malavolti AM, Bassler D, Arlettaz-Mieth R, Faldella G, Latal B, Natalucci G. Bronchopulmonary dysplasia-impact of severity and timing of diagnosis on neurodevelopment of preterm infants: a retrospective cohort study. BMJ Paediatr Open. 2018; 2:e000165.
Article
4. You JY, Shu C, Gong CH, Liu S, Fu Z. Readmission of children with bronchopulmonary dysplasia in the first 2 years of life: a clinical analysis of 121 cases. Zhongguo Dang Dai Er Ke Za Zhi. 2017; 19:1056–60.
5. Bozzetto S, Carraro S, Tomasi L, Berardi M, Zanconato S, Baraldi E. Health-related quality of life in adolescent survivors of bronchopulmonary dysplasia. Respirology. 2016; 21:1113–7.
Article
6. Redline RW. Classification of placental lesions. Am J Obstet Gynecol. 2015; 213(4 Suppl):S21–8.
Article
7. Gravett MG, Hitti J, Hess DL, Eschenbach DA. Intrauterine infection and preterm delivery: evidence for activation of the fetal hypothalamic-pituitary-adrenal axis. Am J Obstet Gynecol. 2000; 182:1404–13.
Article
8. Balany J, Bhandari V. Understanding the impact of infection, inflammation, and their persistence in the pathogenesis of bronchopulmonary dysplasia. Front Med (Lausanne). 2015; 2:90.
Article
9. Eriksson L, Haglund B, Odlind V, Altman M, Ewald U, Kieler H. Perinatal conditions related to growth restriction and inflammation are associated with an increased risk of bronchopulmonary dysplasia. Acta Paediatr. 2015; 104:259–63.
Article
10. Stranak Z, Feyereisl J, Korcek P, Feyereislova S, Krofta L. Procalcitonin is more likely to be released by the fetus rather than placental tissue during chorioamnionitis. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub. 2016; 160:499–502.
Article
11. Torchin H, Lorthe E, Goffinet F, Kayem G, Subtil D, Truffert P, et al. Histologic chorioamnionitis and bronchopulmonary dysplasia in preterm infants: the epidemiologic study on low gestational ages 2 cohort. J Pediatr. 2017; 187:98–104.e3.
Article
12. Matsumura H, Ichiba H, Ohnishi S, Saito M, Shintaku H. Histologic chorioamnionitis, amniotic fluid interleukin 6, krebs von den lungen 6, and transforming growth factor β1 for the development of neonatal bronchopulmonary dysplasia. Jpn Clin Med. 2017; 8:1179066017696076.
Article
13. Kaneko M, Sato M, Ogasawara K, Imamura T, Hashimoto K, Momoi N, et al. Serum cytokine concentrations, chorioamnionitis and the onset of bronchopulmonary dysplasia in premature infants. J Neonatal Perinatal Med. 2017; 10:147–55.
Article
14. Samejima T, Takechi K. Elevated C-reactive protein levels in histological chorioamnionitis at term: impact of funisitis on term neonates. J Matern Fetal Neonatal Med. 2017; 30:1428–33.
Article
15. Jobe AH, Bancalari E. Bronchopulmonary dysplasia. Am J Respir Crit Care Med. 2001; 163:1723–9.
Article
16. Salafia CM, Weigl C, Silberman L. The prevalence and distribution of acute placental inflammation in uncomplicated term pregnancies. Obstet Gynecol. 1989; 73:383–9.
Article
17. Stoll BJ, Hansen NI, Bell EF, Shankaran S, Laptook AR, Walsh MC, et al. Neonatal outcomes of extremely preterm infants from the NICHD Neonatal Research Network. Pediatrics. 2010; 126:443–56.
Article
18. Palta M, Gabbert D, Weinstein MR, Peters ME. Multivariate assessment of traditional risk factors for chronic lung disease in very low birth weight neonates. The Newborn Lung Project. J Pediatr. 1991; 119:285–92.
19. Yu KH, Li J, Snyder M, Shaw GM, O'Brodovich HM. The genetic predisposition to bronchopulmonary dysplasia. Curr Opin Pediatr. 2016; 28:318–23.
Article
20. Ali Z, Schmidt P, Dodd J, Jeppesen DL. Bronchopulmonary dysplasia: a review. Arch Gynecol Obstet. 2013; 288:325–33.
Article
21. Glaser K, Speer CP. Pre and Postnatal inflammation in the pathogenesis of bronchopulmonary dysplasia, in Bronchopulmonary Dysplasia, edited by Bhandari V, Cham. Springer International Publishing;2016. p.p. 55–77.
22. Viscardi RM. Perinatal inflammation and lung injury. Semin Fetal Neonatal Med. 2012; 17:30–5.
Article
23. Speer CP. Chorioamnionitis, postnatal factors and proinflammatory response in the pathogenetic sequence of bronchopulmonary dysplasia. Neonatology. 2009; 95:353–61.
Article
24. Palmsten K, Nelson KK, Laurent LC, Park S, Chambers CD, Parast MM. Subclinical and clinical chorioamnionitis, fetal vasculitis, and risk for preterm birth: a cohort study. Placenta. 2018; 67:54–60.
Article
25. Watterberg KL, Demers LM, Scott SM, Murphy S. Chorioamnionitis and early lung inflammation in infants in whom bronchopulmonary dysplasia develops. Pediatrics. 1996; 97:210–5.
Article
26. Yoon BH, Romero R, Jun JK, Park KH, Park JD, Ghezzi F, et al. Amniotic fluid cytokines (interleukin-6, tumor necrosis factor-alpha, interleukin-1 beta, and interleukin-8) and the risk for the development of bronchopulmonary dysplasia. Am J Obstet Gynecol. 1997; 177:825–30.
27. Hartling L, Liang Y, Lacaze-Masmonteil T. Chorioamnionitis as a risk factor for bronchopulmonary dysplasia: a systematic review and metaanalysis. Arch Dis Child Fetal Neonatal Ed. 2012; 97:F8–17.
Article
28. Kramer BW, Kallapur S, Newnham J, Jobe AH. Prenatal inflammation and lung development. Semin Fetal Neonatal Med. 2009; 14:2–7.
Article
29. Kramer BW, Ladenburger A, Kunzmann S, Speer CP, Been JV, van Iwa-arden JF, et al. Intravenous lipopolysaccharide-induced pulmonary maturation and structural changes in fetal sheep. Am J Obstet Gynecol. 2009; 200:195e1–10.
Article
30. Thomas W, Speer CP. Chorioamnionitis: important risk factor or innocent bystander for neonatal outcome? Neonatology. 2011; 99:177–87.
Article
31. Choi CW, Lee J, Oh JY, Lee SH, Lee HJ, Kim BI. Protective effect of chorioamnionitis on the development of bronchopulmonary dysplasia triggered by postnatal systemic inflammation in neonatal rats. Pediatr Res. 2016; 79:287–94.
Article
32. Paananen R, Husa AK, Vuolteenaho R, Herva R, Kaukola T, Hallman M. Blood cytokines during the perinatal period in very preterm infants: relationship of inflammatory response and bronchopulmonary dysplasia. J Pediatr. 2009; 154:39–43.e3.
Article
33. Plakkal N, Soraisham AS, Trevenen C, Freiheit EA, Sauve R. Histological chorioamnionitis and bronchopulmonary dysplasia: a retrospective cohort study. J Perinatol. 2013; 33:441–5.
Article
34. Ballard AR, Mallett LH, Pruszynski JE, Cantey JB. Chorioamnionitis and subsequent bronchopulmonary dysplasia in very-low-birth weight infants: a 25-year cohort. J Perinatol. 2016; 36:1045–8.
Article
35. Stimac M, Juretić E, Vukelić V, Matasić NP, Kos M, Babić D. Effect of chorioamnionitis on mortality, early onset neonatal sepsis and bronchopulmonary dysplasia in preterm neonates with birth weight of <1,500 grams. Coll Antropol. 2014; 38:167–71.
36. Choi CW. Chorioamnionitis: is a major player in the development of bronchopulmonary dysplasia? Korean J Pediatr. 2017; 60:203–7.
Article
37. Ansar W, Ghosh S. C-reactive protein and the biology of disease. Immunol Res. 2013; 56:131–42.
Article
38. Lee J, Bang YH, Lee EH, Choi BM, Hong YS. The influencing factors on procalcitonin values in newborns with noninfectious conditions during the first week of life. Korean J Pediatr. 2017; 60:10–6.
Article
39. Chiesa C, Signore F, Assumma M, Buffone E, Tramontozzi P, Osborn JF, et al. Serial measurements of C-reactive protein and interleukin-6 in the immediate postnatal period: reference intervals and analysis of maternal and perinatal confounders. Clin Chem. 2001; 47:1016–22.
Article
40. Chiesa C, Natale F, Pascone R, Osborn JF, Pacifico L, Bonci E, et al. C reactive protein and procalcitonin: reference intervals for preterm and term newborns during the early neonatal period. Clin Chim Acta. 2011; 412:1053–9.
Article
Full Text Links
  • PN
Actions
Cited
CITED
export Copy
Close
Share
  • Twitter
  • Facebook
Similar articles
Copyright © 2024 by Korean Association of Medical Journal Editors. All rights reserved.     E-mail: koreamed@kamje.or.kr