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The impact of chorioamnionitis on neurodevelopmental outcomes at 3, 8 and 18 years in low-birthweight preterm infants

Journal of Perinatology volume 33, pages 548–552 (2013)Cite this article

Subjects

Abstract

Objective:

To assess the long-term cognitive, behavioral and academic status of preterm children exposed to clinical chorioamnionitis.

Study Design:

In total, 985 infants (<37 weeks and 2500 g at birth) were recruited in a multisite interventional research program. Of these, 43 case-infants were identified based on documented diagnosis of maternal clinical chorioamnionitis. Infants with chorioamnionitis were compared with the remainder of the cohort after controlling for maternal and infant variables. All infants underwent cognitive, behavioral and academic achievement assessments at 3, 8 and 18 years. Standardized cognitive and academic achievement scores were cutoff at 2 s.d.’s below the mean, behavioral scores were cutoff at a T-score >70 and examined with χ2 statistics. Mean scores were evaluated using preliminary bivariate analysis and were followed by multiple regression models predicting child outcomes.

Result:

Overall, children with chorioamnionitis did not have lower scores on any assessment at any age. Children without chorioamnionitis performed significantly lower at 8 years on the Woodcock–Johnson reading subscore and the mean score of the Peabody Picture Vocabulary Test (PPVT). No significant difference persisted to 18-year follow-up. In logistic regression, chorioamnionitis independently predicted higher PPVT scores at 8 years, but not lower performance scores on the Woodcock–Johnson reading subscore.

Conclusion:

Clinical chorioamnionitis was not associated with adverse neurodevelopmental outcomes in this group of preterm infants <37 weeks and 2500 g.

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References

  1. Tita AT, Andrews WW . Diagnosis and management of clinical chorioamnionitis. Clin Perinatol 2010; 37 (2): 339–354.

    Article  Google Scholar 

  2. Yoon BH, Romero R, Moon JB, Shim SS, Kim M, Kim G et al. Clinical significance of intra-amniotic inflammation in patients with preterm labor and intact membranes. Am J Obstet Gynecol 2001; 185 (5): 1130–1136.

    Article  CAS  Google Scholar 

  3. Morales WJ, Washington SR, Lazar AJ . The effect of chorioamnionitis on perinatal outcome in preterm gestation. J Perinatol 1987; 7 (2): 105–110.

    CAS  PubMed  Google Scholar 

  4. Aziz N, Cheng YW, Caughey AB . Neonatal outcomes in the setting of preterm premature rupture of membranes complicated by chorioamnionitis. J Matern Fetal Neonatal Med 2009; 22 (9): 780–784.

    Article  Google Scholar 

  5. Yoder PR, Gibbs RS, Blanco JD, Castaneda YS, St Clair PJ . A prospective, controlled study of maternal and perinatal outcome after intra-amniotic infection at term. Am J Obstet Gynecol 1983; 145 (6): 695–701.

    Article  CAS  Google Scholar 

  6. Alexander JM, McIntire DM, Leveno KJ . Chorioamnionitis and the prognosis for term infants. Obstet Gynecol 1999; 94 (2): 274–278.

    CAS  Google Scholar 

  7. Wu YW, Escobar GJ, Grether JK, Croen LA, Greene JD, Newman TB . Chorioamnionitis and cerebral palsy in term and near-term infants. J Am Med Assoc 2003; 290 (20): 2677–2684.

    Article  CAS  Google Scholar 

  8. Burd I, Balakrishnan B, Kannan S . Models of fetal brain injury, intrauterine inflammation, and preterm birth. Am J Reprod Immunol 2012; 67 (4): 287–294.

    Article  CAS  Google Scholar 

  9. Hendson L, Russell L, Robertson CM, Liang Y, Chen Y, Abdalla A et al. Neonatal and neurodevelopmental outcomes of very low birth weight infants with histologic chorioamnionitis. J Pediatr 2011; 158 (3): 397–402.

    Article  Google Scholar 

  10. Dexter SC, Pinar H, Malee MP, Hogan J, Carpenter MW, Vohr BR . Outcome of very low birth weight infants with histopathologic chorioamnionitis. Obstet Gynecol 2000; 96 (2): 172–177.

    CAS  Google Scholar 

  11. Andrews WW, Cliver SP, Biasini F, Peralta-Carcelen AM, Rector R, Alriksson-Schmidt AI et al. Early preterm birth: association between in utero exposure to acute inflammation and severe neurodevelopmental disability at 6 years of age. Am J Obstet Gynecol 2008; 198 (4): 466 e461–466 e411.

    Article  Google Scholar 

  12. Limperopoulos C, Bassan H, Sullivan NR, Soul JS, Robertson RL, Moore M et al. Positive screening for autism in ex-preterm infants: prevalence and risk factors. Pediatrics 2008; 121 (4): 758–765.

    Article  Google Scholar 

  13. The Infant Health and Development Program. Enhancing the outcomes of low-birth-weight, premature infants. A multisite, randomized trial. J Am Med Assoc 1990; 263 (22): 3035–3042.

    Article  Google Scholar 

  14. Brooks-Gunn J, McCarton CM, Casey PH, McCormick MC, Bauer CR, Bernbaum JC et al. Early intervention in low-birth-weight premature infants. Results through age 5 years from the Infant Health and Development Program. J Am Med Assoc 1994; 272 (16): 1257–1262.

    Article  CAS  Google Scholar 

  15. McCarton CM, Brooks-Gunn J, Wallace IF, Bauer CR, Bennett FC, Bernbaum JC et al. Results at age 8 years of early intervention for low-birth-weight premature infants. The Infant Health and Development Program. J Am Med Assoc 1997; 277 (2): 126–132.

    Article  CAS  Google Scholar 

  16. McCormick MC, Brooks-Gunn J, Buka SL, Goldman J, Yu J, Salganik M et al. Early intervention in low birth weight premature infants: results at 18 years of age for the Infant Health and Development Program. Pediatrics 2006; 117 (3): 771–780.

    Article  Google Scholar 

  17. Terman LM, Merrill MA . Stanford-Binet Intelligence Scale: Manual for the Third Revision, Form L-M. Houghton Mifflin: Boston, MA, 1973.

    Google Scholar 

  18. Dunn LM, Dunn LM . Manual for the Peabody Picture Vocabulary Test-Revised. American Guidance Service: Circle Pines, MN, 1981.

    Google Scholar 

  19. Wechsler D . Manual for the Wechsler Intelligence Scale for Children-Third Edition. Psychological Corp: San Antonio, TX, 1991.

    Google Scholar 

  20. Psychological Corporation. Wechsler Abbreviated Scale of Intelligence. Psychological Corporation: San Antonio, TX, 1999.

  21. Dunn LM, Dunn LM . Peabody Picture Vocabulary Test 3rd edn. American Guidance Service: Circle Pines, MN, 1997.

    Google Scholar 

  22. Achenbach TM, Edelbrock C, Howell CT . Empirically based assessment of the behavioral/emotional problems of 2- and 3- year-old children. J Abnorm Child Psychol 1987; 15 (4): 629–650.

    Article  CAS  Google Scholar 

  23. Achenbach T, Edelbrock C . Manual for the Child Behavior Checklist and Revised Child Behavior Profile. Queen City Printers: Burlington, VT, 1983.

    Google Scholar 

  24. Woodcock R, Johnson M . Manual for the Woodcock–Johnson Tests of Achievement-Revised. RCL Enterprises: Allen, TX, 1990.

    Google Scholar 

  25. Scott DT, Bauer CR, Kraemer HC, Tyson J . A neonatal health index for preterm infants. Pediatr Res 1989; 25 (4): 263A.

    Google Scholar 

  26. Bradley RH, Caldwell BM . Using the home inventory to assess the family environment. Pediatr Nurs 1988; 14 (2): 97–102.

    CAS  PubMed  Google Scholar 

  27. Redline RW, Minich N, Taylor HG, Hack M . Placental lesions as predictors of cerebral palsy and abnormal neurocognitive function at school age in extremely low birth weight infants (&lt;1 kg). Pediatr Dev Pathol 2007; 10 (4): 282–292.

    Article  Google Scholar 

  28. Suppiej A, Franzoi M, Vedovato S, Marucco A, Chiarelli S, Zanardo V . Neurodevelopmental outcome in preterm histological chorioamnionitis. Early Hum Dev 2009; 85 (3): 187–189.

    Article  Google Scholar 

  29. Watterberg KL, Demers LM, Scott SM, Murphy S . Chorioamnionitis and early lung inflammation in infants in whom bronchopulmonary dysplasia develops. Pediatrics 1996; 97 (2): 210–215.

    CAS  Google Scholar 

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Acknowledgements

The Infant Health and Development Program was supported, in its first 3 years, by the Robert Wood Johnson Foundation; follow-up evaluations were supported by the Pew Charitable Trust, the National Institute of Child Health and Human Development and by the Maternal Child Health Bureau, with the Robert Wood Johnson Foundation.

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Authors and Affiliations

  1. Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, AR, USA

    S A Burns, R E Lyle, P H Casey, K H Burns & K W Barrett

  2. Department of Family Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, USA

    L Whiteside-Mansell

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  1. S A Burns
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Correspondence to K H Burns.

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Burns, S., Lyle, R., Casey, P. et al. The impact of chorioamnionitis on neurodevelopmental outcomes at 3, 8 and 18 years in low-birthweight preterm infants. J Perinatol 33, 548–552 (2013). https://doi.org/10.1038/jp.2012.160

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