Histologic Chorioamnionitis and Neurodevelopment in Preterm Infants.

Area of Science:

• Neonatal Health
• Neurodevelopmental Pediatrics
• Obstetrics and Gynecology

Background:

• Chorioamnionitis increases risks for preterm birth and potential neurodevelopmental impairments.
• Evidence linking inflammation from chorioamnionitis to neurodevelopmental issues is inconsistent.
• Histologic chorioamnionitis (HCA) may directly affect fetal neurodevelopment beyond prematurity.

Purpose of the Study:

• To determine if moderate to severe HCA is directly associated with adverse motor performance in preterm infants.
• To assess the independent effect of HCA on motor skills, excluding indirect effects of premature birth.
• To investigate the mediating role of premature birth in the HCA-neurodevelopmental outcome relationship.

Main Methods:

• Prospective, population-based cohort study of preterm infants (gestational age ≤32 weeks).
• Compared motor, cognitive, and language scores (Bayley Scales of Infant and Toddler Development, Third Edition) between infants with moderate to severe HCA and those with no/mild HCA.
• Utilized multivariable regression and causal mediation analysis to assess direct and indirect associations.

Main Results:

• Moderate to severe HCA was independently associated with lower motor, cognitive, and language scores at 22-26 months corrected age.
• Infants with HCA were born significantly earlier (median 2.6 weeks) than controls.
• Causal mediation analysis indicated that 75% of the motor deficit was a direct effect of HCA, with 25% mediated by earlier preterm birth.

Conclusions:

• Moderate to severe HCA is directly linked to adverse motor neurodevelopment in preterm infants.
• HCA impacts neurodevelopment both by inducing earlier preterm birth and through direct inflammatory effects.
• Findings support clinical counseling and targeted anti-inflammatory interventions for high-risk pregnancies.