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Published on: November 20, 2015
Intrauterine Inflammation, Excessive Fetal Growth and Respiratory Morbidities in Moderate-To-Late Preterm Neonates
Kyoko Yokoi1, Osuke Iwata1, Satoru Kobayashi2
1Department of Pediatrics and Neonatology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan.
Insights
Intrauterine inflammation, indicated by chorioamnionitis, increases respiratory morbidities in moderate-to-late preterm neonates. Early prediction and monitoring are crucial for these vulnerable infants.
Area of Science:
- Neonatal Medicine
- Perinatal Research
- Pediatric Respiratory Medicine
Background:
- Respiratory morbidities pose significant risks to neonates, necessitating early prediction.
- Intrauterine inflammation is a known factor in respiratory issues for very preterm and term infants.
- The impact of intrauterine inflammation on moderate-to-late preterm neonates remains less understood.
Purpose of the Study:
- To investigate the association between intrauterine inflammation and respiratory morbidities in moderate-to-late preterm neonates (32+0 to 36+6 weeks gestation).
Main Methods:
- A retrospective observational study of 242 neonates born between 32+0 and 34+6 weeks gestation.
- Respiratory morbidities were defined as requiring invasive mechanical ventilation for longer than 3 days.
- Multivariable logistic regression analysis assessed the correlation between respiratory morbidities and intrauterine inflammation markers.
Main Results:
- Chorioamnionitis (OR: 2.8) was significantly associated with increased respiratory morbidities.
- Respiratory distress syndrome (OR: 9.1), lower gestational age, higher birth-weight z-score, and lower cord blood pH were also predictive.
- The model identified key factors contributing to respiratory morbidities in this cohort.
Conclusions:
- Intrauterine inflammation, specifically chorioamnionitis, is linked to respiratory morbidities in moderate-to-late preterm neonates.
- The detrimental effects of intrauterine inflammation on lung development appear consistent across various gestational ages.
- Current neonatal intensive care unit admission policies based solely on birth weight may overlook at-risk neonates.
Introduction:
Respiratory morbidities in neonates are often progressive and life-threatening, and its early prediction is crucial. Intrauterine inflammation is one of the key control variables of respiratory morbidities in both very preterm and term neonates; however, little is known about its effects in the remaining group of moderate-to-late preterm neonates born between 32+0 and 36+6 weeks of gestation. This study aimed to confirm whether intrauterine inflammation is associated with respiratory morbidities in moderate-to-late preterm neonates.
Methods:
A single-center retrospective observational study was conducted in neonates born between 32+0 and 34+6 weeks of gestation between April 2013 and March 2018. The correlation between respiratory morbidities (defined as a requirement for invasive mechanical ventilation longer than the median duration of 3 days) and intrauterine inflammation was assessed using multivariable logistic regression analysis.
Results:
The study population comprised 242 neonates born at 33.7 ± 0.8 weeks of gestation and weighing 1,936 ± 381 g. The multivariable model to predict the outcome comprised respiratory distress syndrome (odds ratio [OR]: 9.1; 95% confidence interval [CI]: 3.7-22.5; p < 0.001), lower gestational age (per week; OR: 0.5; 95% CI: 0.3-0.8; p < 0.005), higher birth-weight z-score (OR: 1.6; 95% CI: 1.2-2.2; p < 0.005), lower cord blood pH (per 0.10; OR: 0.5; 95% CI: 0.3-0.7; p < 0.005), and chorioamnionitis (OR: 2.8; 95% CI: 1.1-7.2; p < 0.05).
Conclusion:
Together with the incidence of respiratory distress syndrome and gestational age, chorioamnionitis and high birth-weight z-scores were associated with an increased incidence of respiratory morbidities in moderate-to-late preterm neonates. The deleterious impact of intrauterine inflammation on the lungs may be common in neonates of virtually all gestational ages. Traditional admission policy of neonatal intensive care units based on a threshold birth-weight, may leave a group of neonates without close observation despite their increased risks for respiratory morbidities.
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