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  • Clinical Research Article
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Impact of maternal infection on outcomes in extremely preterm infants

Pediatric Research volume 95, pages 573–578 (2024)Cite this article

Abstract

Background

Infants born less than 29 weeks, or extremely preterm (EPT), experience increased morbidity and mortality. We hypothesized that exposure to maternal infection might contribute to neurodevelopmental impairment (NDI) or death at 2 years of age.

Methods

We conducted a retrospective cohort study of EPT infants from January 2010 to December 2020. Maternal data extracted included maternal infections, classified as extrauterine or intrauterine. Placental pathologic and infant data were extracted. The primary outcome was NDI or death at 2 years of age.

Results

548 EPT infants were born to 496 pregnant people: 379 (69%) were not exposed to any documented maternal infection prenatally, 124 (23%) to extrauterine infection, and 45 (8%) to intrauterine infection. Neither diagnosis of maternal extrauterine nor intrauterine infection was associated with NDI or death at 2 years of age (p > 0.05). Acute histologic chorioamnionitis was associated with NDI or death at 2 years of age (p = 0.033).

Conclusions

Maternal infection was not associated with NDI or death at 2 years of age in EPT infants. However, acute histologic chorioamnionitis was associated with this outcome. Further work should investigate the differential influence of infection and immune response with this pathology as relates to outcomes in EPT infants.

Impact

  • Maternal infection was not associated with neurodevelopmental impairment (NDI) or death at 2 years of age in extremely preterm (EPT) infants. This is reassuring support that mechanisms at the maternal-fetal interface largely protect the EPT infant.

  • However, pathologic findings of acute histologic chorioamnionitis were associated with NDI and death at 2 years of age.

  • Further work should investigate the differential influence of infection and immune response with acute histologic chorioamnionitis on pathology as relates to outcomes in EPT infants.

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Data availability

The datasets generated and analyzed during the current study are available from the corresponding author on reasonable request.

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Acknowledgements

The authors thank Pollieanna Sepulveda for her assistance in data extraction, and Dr. Catherine Spong for her overall guidance on the project. This research was made possible through internal funding. C.L.H. is supported by grants K23HD103876 and L30HD109864.

Author information

Authors and Affiliations

  1. Department of Obstetrics & Gynecology, University of Texas Southwestern Medical Center, Dallas, TX, USA

    Christina L. Herrera & Jessica E. Pruszynski

  2. Parkland Health, Dallas, TX, USA

    Christina L. Herrera & Imran Mir

  3. University of Texas Southwestern Medical School, Dallas, TX, USA

    Priyanka S. Kadari

  4. Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX, USA

    Imran Mir

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  1. Christina L. Herrera
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  2. Priyanka S. Kadari
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  4. Imran Mir
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Contributions

Each author listed has meet the following criteria: substantial contributions to conception and design (C.L.H., I.M.), acquisition of data (C.L.H., I.M., P.S.K.), or analysis and interpretation of data (all authors); drafting the article or revising it critically for important intellectual content (all authors); and final approval of the version to be published (all authors).

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Correspondence to Christina L. Herrera.

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Herrera, C.L., Kadari, P.S., Pruszynski, J.E. et al. Impact of maternal infection on outcomes in extremely preterm infants. Pediatr Res 95, 573–578 (2024). https://doi.org/10.1038/s41390-023-02898-3

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