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Risk of brain damage in premature infants under 34 weeks of gestational age exposed to histological chorioamnionitis
Noelia Guillén1, Carolina Llerena1, Susan Samalvides1
1Universidad Peruana Cayetano Heredia, Lima, Perú.
Insights
Histological chorioamnionitis (HCA) increases brain damage risk in premature infants. This infection is linked to intraventricular hemorrhage and white matter lesions, especially in the first 30 days of life.
Area of Science:
- Neonatalogy
- Perinatal Medicine
- Neurology
Background:
- Histological chorioamnionitis (HCA) is a placental inflammation affecting premature infants.
- The impact of HCA on brain development in preterm neonates requires further investigation.
Purpose of the Study:
- To evaluate the association between HCA and brain damage in premature infants (<34 weeks gestational age).
Main Methods:
- A cohort study included 85 premature infants (<34 weeks gestational age) with placental histopathology.
- Infants were monitored for brain damage via ultrasound at 0-7 days, 7-30 days, and 40 weeks corrected gestational age.
Main Results:
- 42% of infants were exposed to HCA.
- HCA correlated with intraventricular hemorrhage (IVH) within the first week and white matter lesions between 7-30 days.
- Chorioamnionitis specifically increased neurological damage risk in the first 30 days.
Conclusions:
- HCA is a significant risk factor for brain injuries in preterm infants.
- Early HCA exposure is linked to increased IVH and white matter damage.
- Preterm infants with HCA exhibit more severe brain damage at 40 weeks corrected gestational age.
Objectives:
To assess the risk of brain damage in premature infants under 34 weeks of gestational age exposed to histological chorioamnionitis (HCA).
Materials And Methods:
A cohort study was conducted at the Hospital Cayetano Heredia, during 2015. Premature infants under 34 weeks of gestational age, who had histopathological examination of the placenta, were included. The types of HCA evaluated were sub-chorionitis, chorionitis, chorioamnionitis, with or without funisitis. Brain damage was evaluated in three age periods, between 0 and 7 days, between 7 and 30 days and at 40 weeks of corrected gestational age. A neurological follow-up and regular controls were performed with brain ultrasound.
Results:
A total of 85 premature infants were included, 47.1% were women and the mean gestational age was 30.9 weeks. From the total, 42% (36/85) were born exposed to HCA. Premature rupture of membranes was the main cause of sepsis, which was related to neurological damage. HCA was associated with intraventricular hemorrhage (IVH) during the first week and with white matter lesions between 7 and 30 days of age (p = 0.035). The chorioamnionitis type of HCA was associated with neurological damage during the first week (RR = 2.11, 95% CI: 1.09-4.11) and between 7 and 30 days of age (RR = 2.72, 95% CI: 1.07-6.88).
Conclusions:
Chorioamnionitis was a risk factor for developing brain injuries in premature infants under 34 weeks of gestational age. It was also a risk factor for HIV during the first 7 days and for white matter injuries between 7 and 30 days of age. At 40 weeks of corrected gestational age, extreme premature infants with HCA had more extensive brain damage.
