Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Original Article
  • Published:

Chorioamnionitis, respiratory distress syndrome and bronchopulmonary dysplasia in extremely low birth weight infants

Abstract

Objective:

To determine if histologic chorioamnionitis (HC) in the presence of respiratory distress syndrome (RDS) augments adverse pulmonary outcomes in extremely low birth weight (ELBW) infants.

Study Design:

We retrospectively identified 184 ELBW infants who were born at and admitted to the neonatal intensive care units between June 2005 and June 2009.

Results:

The mean gestational age of the cases was 27±2 weeks, and the mean birth weight was 791±147 g. A total of 88% (161/184) of patients developed bronchopulmonary dysplasia (BPD). HC was observed in 71 of 238 infants (39%). When infants were divided on the basis of the presence or absence of HC and RDS, the incidence of moderate or severe BPD and duration of oxygen requirement were greater in the HC+RDS+ group than in the HC−RDS+ or HC+RDS− groups. The combination of prenatal (HC) and postnatal (RDS) injuries increased significantly the risk for BPD. In the multivariate analysis, the significant predictors of developing BPD were low gestational age (odds ratio (OR), 0.6; confidence interval (CI), 0.4 to 0.7) and exposure to both HC and RDS (OR, 4.7; CI, 1.1 to 20.2).

Conclusion:

The HC and RDS work synergistically to induce lung injury in ELBW infants. Chorioamnionitis may interact with RDS to further increase the risk of BPD, despite either HC or RDS could not show independent significant association with BPD.

This is a preview of subscription content, access via your institution

Access options

Buy this article

Prices may be subject to local taxes which are calculated during checkout

Figure 1

Similar content being viewed by others

References

  1. Holzman C, Lin X, Senagore P, Chung H . Histologic chorioamnionitis and preterm delivery. Am J Epidemiol 2007; 166: 786–794.

    Article  Google Scholar 

  2. Speer CP . Chorioamnionitis, postnatal factors and proinflammatory response in the pathogenetic sequence of bronchopulmonary dysplasia. Neonatology 2009; 95: 353–361.

    Article  CAS  Google Scholar 

  3. Dempsey E, Chen MF, Kokottis T, Vallerand D, Usher R . Outcome of neonates less than 30 weeks gestation with histologic chorioamnionitis. Am J Perinatol 2005; 22: 155–159.

    Article  CAS  Google Scholar 

  4. Been JV, Rours IG, Kornelisse RF, Jonkers F, de Krijger RR, Zimmermann LJ . Chorioamnionitis alters the response to surfactant in preterm infants. J Pediatr 2010; 156: 10–15 e1.

    Article  CAS  Google Scholar 

  5. Choi CW, Kim BI, Hong JS, Kim EK, Kim HS, Choi JH . Bronchopulmonary dysplasia in a rat model induced by intra-amniotic inflammation and postnatal hyperoxia: morphometric aspects. Pediatr Res 2009; 65: 323–327.

    Article  Google Scholar 

  6. Jobe AH, Kallapur SG . Chorioamnionitis, surfactant, and lung disease in very low birth weight infants. J Pediatr 2010; 156: 3–4.

    Article  Google Scholar 

  7. Verder H, Bohlin K, Kamper J, Lindwall R, Jonsson B . Nasal CPAP and surfactant for treatment of respiratory distress syndrome and prevention of bronchopulmonary dysplasia. Acta Paediatr 2009; 98: 1400–1408.

    Article  Google Scholar 

  8. Jobe AH, Bancalari E . Bronchopulmonary dysplasia. Am J Respir Crit Care Med 2001; 163: 1723–1729.

    Article  CAS  Google Scholar 

  9. Volpe JJ . Perinatal brain injury: from pathogenesis to neuroprotection. Ment Retard Dev Disabil Res Rev 2001; 7: 56–64.

    Article  CAS  Google Scholar 

  10. Bell MJ, Ternberg JL, Feigin RD, Keating JP, Marshall R, Barton L et al. Neonatal necrotizing enterocolitis. Therapeutic decisions based upon clinical staging. Ann Surg 1978; 187: 1–7.

    Article  CAS  Google Scholar 

  11. Salafia CM, Weigl C, Silberman L . The prevalence and distribution of acute placental inflammation in uncomplicated term pregnancies. Obstet Gynecol 1989; 73: 383–389.

    CAS  PubMed  Google Scholar 

  12. Meyer KC, Zimmerman JJ . Inflammation and surfactant. Paediatr Respir Rev 2002; 3: 308–314.

    Article  Google Scholar 

  13. Van Marter LJ, Dammann O, Allred EN, Leviton A, Pagano M, Moore M et al. Chorioamnionitis, mechanical ventilation, and postnatal sepsis as modulators of chronic lung disease in preterm infants. J Pediatr 2002; 140: 171–176.

    Article  Google Scholar 

  14. Laughon M, Allred EN, Bose C, O’Shea TM, Van Marter LJ, Ehrenkranz RA et al. Patterns of respiratory disease during the first 2 postnatal weeks in extremely premature infants. Pediatrics 2009; 123: 1124–1131.

    Article  Google Scholar 

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

    CAS  Google Scholar 

  16. Kent A, Dahlstrom JE . Chorioamnionitis/funisitis and the development of bronchopulmonary dysplasia. J Paediatr Child Health 2004; 40: 356–359.

    Article  CAS  Google Scholar 

  17. Kaukola T, Tuimala J, Herva R, Kingsmore S, Hallman M . Cord immunoproteins as predictors of respiratory outcome in preterm infants. Am J Obstet Gynecol 2009; 200: 100 e1-8.

    Article  Google Scholar 

  18. Woldesenbet M, Rosenfeld CR, Ramilo O, Johnson-Welch S, Perlman JM . Severe neonatal hypoxic respiratory failure correlates with histological chorioamnionitis and raised concentrations of interleukin 6 (IL6), IL8 and C-reactive protein. Arch Dis Child Fetal Neonatal Ed 2008; 93: F413–F417.

    Article  CAS  Google Scholar 

  19. Been JV, Zimmermann LJ . Histological chorioamnionitis and respiratory outcome in preterm infants. Arch Dis Child Fetal Neonatal Ed 2009; 94: F218–F225.

    Article  CAS  Google Scholar 

  20. Lahra MM, Beeby PJ, Jeffery HE . Maternal versus fetal inflammation and respiratory distress syndrome: a 10-year hospital cohort study. Arch Dis Child Fetal Neonatal Ed 2009; 94: F13–F16.

    Article  CAS  Google Scholar 

  21. Lahra MM, Jeffery HE . A fetal response to chorioamnionitis is associated with early survival after preterm birth. Am J Obstet Gynecol 2004; 190: 147–151.

    Article  Google Scholar 

  22. Thebaud B, Abman SH . Bronchopulmonary dysplasia: where have all the vessels gone? Roles of angiogenic growth factors in chronic lung disease. Am J Respir Crit Care Med 2007; 175: 978–985.

    Article  CAS  Google Scholar 

  23. Kramer BW, Kaemmerer U, Kapp M, Herbst D, Marx A, Berg D et al. Decreased expression of angiogenic factors in placentas with chorioamnionitis after preterm birth. Pediatr Res 2005; 58: 607–612.

    Article  CAS  Google Scholar 

  24. Been JV, Zimmermann LJ, Debeer A, Kloosterboer N, van Iwaarden JF . Bronchoalveolar lavage fluid from preterm infants with chorioamnionitis inhibits alveolar epithelial repair. Respir Res 2009; 10: 116.

    Article  Google Scholar 

  25. Heremans H, Dillen C, Groenen M, Matthys P, Billiau A . Role of interferon-gamma and nitric oxide in pulmonary edema and death induced by lipopolysaccharide. Am J Respir Crit Care Med 2000; 161: 110–117.

    Article  CAS  Google Scholar 

  26. Torrance HL, Voorbij HA, Wijnberger LD, van Bel F, Visser GH . Lung maturation in small for gestational age fetuses from pregnancies complicated by placental insufficiency or maternal hypertension. Early Hum Dev 2008; 84: 465–469.

    Article  CAS  Google Scholar 

  27. Jobe AH . Antenatal factors and the development of bronchopulmonary dysplasia. Semin Neonatol 2003; 8: 9–17.

    Article  Google Scholar 

  28. Bose CL, Dammann CE, Laughon MM . Bronchopulmonary dysplasia and inflammatory biomarkers in the premature neonate. Arch Dis Child Fetal Neonatal Ed 2008; 93: F455–F461.

    Article  CAS  Google Scholar 

  29. Bhatt AJ, Pryhuber GS, Huyck H, Watkins RH, Metlay LA, Maniscalco WM . Disrupted pulmonary vasculature and decreased vascular endothelial growth factor, Flt-1, and TIE-2 in human infants dying with bronchopulmonary dysplasia. Am J Respir Crit Care Med 2001; 164: 1971–1980.

    Article  CAS  Google Scholar 

  30. Ambalavanan N, Carlo WA . Bronchopulmonary dysplasia: new insights. Clin Perinatol 2004; 31: 613–628.

    Article  Google Scholar 

Download references

Acknowledgements

This study was supported by a grant of the Korea Healthcare Technology R&D Project, Ministry of Health and Welfare (A080588-25).

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Beyong II Kim.

Ethics declarations

Competing interests

The authors declare no conflict of interest.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Lee, H., Kim, EK., Kim, HS. et al. Chorioamnionitis, respiratory distress syndrome and bronchopulmonary dysplasia in extremely low birth weight infants. J Perinatol 31, 166–170 (2011). https://doi.org/10.1038/jp.2010.113

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/jp.2010.113

Keywords

This article is cited by

Search

Quick links