Original Article

Journal of Perinatology (2005) 25, 189–192. doi:10.1038/sj.jp.7211240 Published online 9 December 2004

Histologic Chorioamnionitis: An Occult Marker of Severe Pulmonary Hypertension in the Term Newborn

Mesfin Woldesenbet MD1 and Jeffrey M Perlman MB2

  1. 1Department of Pediatrics (M.W.), UT Southwestern Medical Center, Dallas, TX, USA
  2. 2New York Presbyterian Hospital (J.M.P.), Weil Medical College of Cornell University, New York, NY 10021, USA

Correspondence: Mesfin Woldesenbet, MD, Department of Pediatrics, UT Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390-9063, USA

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Abstract

OBJECTIVE:

 

To determine whether the presence of histologic chorioamnionitis is associated with the severity of Persistent Pulmonary Hypertension of the Newborn (PPHN) as evidenced by the use of exogenous nitric oxide (iNO), high-frequency oscillatory ventilation (HFOV), extra-corporeal membrane oxygenation (ECMO) and/or death.

METHODS:

 

Retrospective chart review of term neonates greater than or equal to37 weeks gestation with PPHN. Placental pathology was reviewed. Primary outcome is the use of iNO. Secondary outcomes include the use of HFOV, ECMO and death.

RESULTS:

 

Over 2 years, 29 neonates fulfilled the entry criteria for the study. Interventions included iNO use n=14 (48%), HFOV n=7 (24%) and ECMO n=3 (10%); two neonates died. Histologic chorioamnionitis and/or funisitis was noted in 16 (55%) neonates. The presence of chorioamnionitis and/or funisitis (n=16) versus neither (n=13) was significantly associated with iNO use 11/16 (78%) versus 3/13 (22%) (p=0.02) and HFOV 7/16 (43%) versus 0/13 (0%) (p=0.008) but not to ECMO or death.

CONCLUSION:

 

The presence of histologic chorioamnionitis and/or funisitis is associated with more severe PPHN as indicated by the use of iNO as well as an increased requirement for more advanced respiratory support, that is, HFOV. The mechanism/s contributing to these findings are unclear.

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