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Published on: November 20, 2015
Impact of maternal infection on outcomes in extremely preterm infants
Christina L Herrera1,2, Priyanka S Kadari3, Jessica E Pruszynski4
1Department of Obstetrics & Gynecology, University of Texas Southwestern Medical Center, Dallas, TX, USA. christina.herrera@utsouthwestern.edu.
Insights
Maternal infections did not increase the risk of neurodevelopmental impairment or death in extremely preterm infants. However, acute histologic chorioamnionitis was linked to adverse outcomes in these vulnerable infants.
Area of Science:
- Neonatalogy
- Perinatal Medicine
- Pediatric Neurology
Background:
- Extremely preterm (EPT) infants (<29 weeks gestation) face high risks of morbidity and mortality.
- Maternal infections are a potential contributor to adverse neurodevelopmental outcomes in EPT infants.
- This study investigated the association between maternal infection and neurodevelopmental impairment (NDI) or death at 2 years in EPT infants.
Purpose of the Study:
- To determine if maternal extrauterine or intrauterine infections are associated with NDI or death at 2 years of age in EPT infants.
- To explore the relationship between placental pathology, specifically acute histologic chorioamnionitis, and NDI or death in EPT infants.
- To provide insights into the factors influencing outcomes for extremely preterm neonates.
Main Methods:
- Retrospective cohort study of 548 EPT infants born between January 2010 and December 2020.
- Maternal infection data (extrauterine and intrauterine) and placental pathology were extracted.
- Primary outcome: NDI or death at 2 years of age.
Main Results:
- No significant association was found between maternal extrauterine or intrauterine infections and NDI or death at 2 years (p > 0.05).
- Acute histologic chorioamnionitis was significantly associated with an increased risk of NDI or death at 2 years (p = 0.033).
- Maternal infection did not appear to be a direct driver of adverse outcomes in this cohort.
Conclusions:
- Maternal infection, in general, was not linked to adverse neurodevelopmental outcomes or death in extremely preterm infants.
- Acute histologic chorioamnionitis, a placental inflammation, emerged as a significant risk factor for poor outcomes in EPT infants.
- Further research is needed to elucidate the specific roles of infection and immune responses in acute histologic chorioamnionitis and their impact on EPT infant outcomes.
Background:
Infants born less than 29 weeks, or extremely preterm (EPT), experience increased morbidity and mortality. We hypothesized that exposure to maternal infection might contribute to neurodevelopmental impairment (NDI) or death at 2 years of age.
Methods:
We conducted a retrospective cohort study of EPT infants from January 2010 to December 2020. Maternal data extracted included maternal infections, classified as extrauterine or intrauterine. Placental pathologic and infant data were extracted. The primary outcome was NDI or death at 2 years of age.
Results:
548 EPT infants were born to 496 pregnant people: 379 (69%) were not exposed to any documented maternal infection prenatally, 124 (23%) to extrauterine infection, and 45 (8%) to intrauterine infection. Neither diagnosis of maternal extrauterine nor intrauterine infection was associated with NDI or death at 2 years of age (p > 0.05). Acute histologic chorioamnionitis was associated with NDI or death at 2 years of age (p = 0.033).
Conclusions:
Maternal infection was not associated with NDI or death at 2 years of age in EPT infants. However, acute histologic chorioamnionitis was associated with this outcome. Further work should investigate the differential influence of infection and immune response with this pathology as relates to outcomes in EPT infants.
Impact:
Maternal infection was not associated with neurodevelopmental impairment (NDI) or death at 2 years of age in extremely preterm (EPT) infants. This is reassuring support that mechanisms at the maternal-fetal interface largely protect the EPT infant. However, pathologic findings of acute histologic chorioamnionitis were associated with NDI and death at 2 years of age. Further work should investigate the differential influence of infection and immune response with acute histologic chorioamnionitis on pathology as relates to outcomes in EPT infants.
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