General Obstetrics and Gynecology: ObstetricsChorioamnionitis with a fetal inflammatory response is associated with higher neonatal mortality, morbidity, and resource use than chorioamnionitis displaying a maternal inflammatory response only
Section snippets
Study population
The study cohort included all infants (n = 2012) admitted to the British Columbia's Children's Hospital NICU from January 1996 to October 1997. Infants were identified from standardized data collected by the Canadian Neonatal Network as part of a larger study of 17 tertiary NICUs across Canada, and which has been previously described.9 Trained research assistants abstracted patient information from the mothers' and infants' charts at each participating hospital on a daily basis. Data were entered
Results
Of the 2012 cases, 1296 had a record of placental pathology, representing 64% of all NICU admissions. Histologic evidence of a maternal inflammatory response was identified in 403 cases, or 31% of those with a pathology report. Of those 403 cases, 153 (38%) had maternal inflammation only, whereas 250 (62%) also displayed evidence of fetal inflammation. Infants who had histologic examination of their placentas were significantly (P < .05) more likely than infants who did not have a placental
Comment
The importance of placental pathology for the diagnosis and management of neonatal conditions has long been recognized. As early as 1892, a Scottish obstetrician, Ballantyne stated that “During the intrauterine life, the fetus, the membranes, the cord, and the placenta form an organic whole, and disease of any part must react upon and affect the others.”20 Our findings that 31% of placentas examined in our cohort showed histologic evidence of chorioamnionitis, and that chorioamnionitis is
Acknowledgments
We acknowledge the assistance of Ruth Little in preparing this article, and the Canadian Neonatal Network for use of their data.
References (27)
- et al.
Infection and prematurity and the role of preventative strategies
Semin Neonatol
(2002) Functionally important disorders of the placenta, umbilical cord, and fetal membranes
Hum Pathol
(1987)- et al.
The association of placental abnormalities with maternal and neonatal clinical findings: retrospective cohort study
J Obstet Gynaecol Can
(2003) - et al.
The relationship among inflammatory lesions of the umbilical cord (funisitis), umbilical cord plasma interleukin 6 concentration, amniotic fliud infection, and neonatal sepsis
Am J Obstet Gynecol
(2000) - et al.
SNAP-II and SNAPPE-II: simplified newborn illness severity and mortality risk scores
J Pediatr
(2001) - et al.
The relationship between acute inflammation of the preterm placenta and amnionitic fluid microbiology
Am J Obstet Gynecol
(1992) - et al.
A fetal response to chorioamnionitis is associated with early survival after preterm birth
Am J Obstet Gynecol
(2004) - et al.
The relationship between placental histopathology findings and perinatal outcome in preterm infants
J Matern Fetal Neonatal Med
(2003) - et al.
The effect of chorioamnionitis on perinatal outcome in preterm gestation
J Perinatol
(1987) - et al.
Chorionic plate vessels as an origin of amniotic fluid neutrophils
Pathol Int
(2004)
Maternal and fetal inflammatory responses in unexplained fetal death
J Matern Fetal Neonatal Med
Variations in practice and outcomes in the Canadian NICU Network: 1996-1997
Pediatrics
Pathology of the human placenta
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Supported by the Medical Research Council of Canada and the BC Research Institute for Children's and Women's Health.