[Chorioamnionitis and long-term neurodevelopment in preterm infants: What can we learn from the EPIPAGE-2 cohort...

In cases of premature birth, intrauterine inflammation is common and may be harmful to the developing brain. Three analyses from the EPIPAGE-2 national prospective population-based cohort were recently published. This review provides an overview of recent data on the association between birth in the context of clinical and/or histological chorioamnionitis and long-term neurodevelopment in preterm infants. A major strength of this work lies in the examination of neurodevelopment within a homogeneous birth context, in contrast to the majority of previous studies. Indeed, the various causes of prematurity are based on distinct pathophysiological mechanisms that may influence a child's neurodevelopment differently. This limitation may partially account for the divergence observed with previous publications. These three studies included, from the EPIPAGE-2 cohort, children born alive between 24 and 34 weeks of gestation, following spontaneous labor or premature rupture of membranes. Clinical chorioamnionitis and histological chorioamnionitis, diagnosed after a standardized placental examination, were studied separately. The children's neurodevelopment was assessed at 2 and 5 years of age using standardized tools. At 2 years of age, clinical chorioamnionitis was associated with an increased risk of cerebral palsy (aOR=2.1; 95% CI: 1.1-4.1). In contrast, no significant association was observed between clinical chorioamnionitis and moderate-to-severe neurodevelopmental disorders at 5 years of age. Similarly, isolated histological chorioamnionitis was not associated with neurodevelopmental disorders at 2 or 5 years of age. Among children born prematurely following spontaneous labor or preterm rupture of membranes, exposure to clinical or histological chorioamnionitis does not appear to be associated with adverse neurodevelopmental outcomes at 5 years of age.