Related Experiment Video
Updated: Jun 17, 2025
Modeling Encephalopathy of Prematurity Using Prenatal Hypoxia-ischemia with Intra-amniotic Lipopolysaccharide in Rats
Published on: November 20, 2015
Neurodevelopmental outcomes in extremely preterm infants with placental pathologic evidence of fetal inflammatroy
Yasmeen Alayli1, L Steven Brown2, Kristine Tolentino-Plata1
1Division of Neonatal-Perinatal Medicine, Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX, USA.
Insights
Fetal inflammatory response (FIR) in neonates is not linked to neurodevelopmental impairment (NDI) or death. However, moderate to severe FIR significantly increases the risk of NDI in preterm infants.
Area of Science:
- Neonatalogy
- Perinatal Medicine
- Developmental Pediatrics
Background:
- Fetal inflammatory response (FIR) is associated with adverse neonatal outcomes.
- Preterm infants are particularly vulnerable to neurodevelopmental impairments (NDI).
Purpose of the Study:
- To investigate the association between FIR and its severity with NDI at 2 years of age or death in preterm infants.
- To determine if the degree of fetal inflammation impacts neurodevelopmental outcomes.
Main Methods:
- Retrospective cohort study of infants born before 29 weeks gestational age.
- FIR and its severity diagnosed per the Amsterdam Placental Workshop Group Consensus Statement.
- Neurodevelopmental outcomes assessed using Bayley III at 2 years of age.
Main Results:
- Infants with FIR experienced longer hospitalizations and increased rates of respiratory complications.
- Overall, FIR was not associated with an increased risk of NDI or death.
- Moderate to severe FIR (≥ stage 2) was significantly associated with an increased risk of motor and language impairment or death.
Conclusions:
- This study is the first to demonstrate a link between the severity of FIR and subsequent NDI in preterm infants.
- The findings highlight the critical role of inflammation severity in predicting neurodevelopmental outcomes in vulnerable preterm populations.
Objectives:
Neonates born with fetal inflammatory response (FIR) are at increased risk for adverse neonatal outcomes. Our objective was to determine whether FIR and its severity is associated with neurodevelopmental impairment (NDI) at 2 years of age or death among preterm infants.
Methods:
A retrospective cohort study of prospectively collected data of all infants born <29 weeks gestational age (GA). FIR and its severity were diagnosed according to the Amsterdam Placental Workshop Group Consensus Statement. Neurodevelopmental outcomes among all participants were quantified according to Bayley III.
Results:
Mothers of infants with FIR were significantly younger (P = 0.04) and had a greater prevalence of antenatal steroid use (P < 0.01), infection during pregnancy (P = 0.01), PPROM (P < 0.01), and clinical chorioamnionitis (P < 0.01). Infants with FIR had longer duration of hospitalization (P < 0.01), days on oxygen (P < 0.01), congenital pneumonia (P = 0.03), moderate/severe bronchopulmonary dysplasia (BPD; P < 0.01). Notably, infants with FIR were not at increased risk of NDI or death (primary outcome). Those with moderate to severe FIR (≥ stage 2 FIR) were at increased risk of developing motor & language impairment or death (P < 0.01).
Conclusion:
This is the first report demonstrating an association between the severity of FIR and subsequent NDI in preterm infants born.
Impact Statement:
Fetal Inflammatory Response (FIR) is not associated Neurodevelopmental Impairement (NDI) or Death in preterm infants However, there is significant relationship between moderate to severe FIR and NDI at 2 years of age in preterm infants. This is the first study demonstrating the impact of progression and severity of FIR on NDI or Death in preterm infants. These observations provide additional insight into understanding the impact of intrauterine exposure to inflammation on the NDI or death in preterm infants.
