Chorioamnionitis, mechanical ventilation, and postnatal sepsis as modulators of chronic lung disease in preterm infants.
OBJECTIVE
This case-control study of chronic lung disease (CLD) evaluated the hypothesis that chorioamnionitis promotes CLD and interacts with other risk factors for CLD, including mechanical ventilation and postnatal infection.


METHODS
We identified a population of 193 infants who met our case criteria for CLD whose birth weights were <or=1500 g. These infants were matched 1:1 with control infants for gestational age and hospital of birth.


RESULTS
Univariable analyses revealed decreased CLD risk associated with histologic chorioamnionitis and increased risk associated with mechanical ventilation >7 days and culture-documented sepsis. In multivariable analyses, infants were at greatest risk for CLD when they had exposure to both chorioamnionitis and either mechanical ventilation >7 days (odds ratio, 3.2; 95% confidence interval, 0.9-11) or postnatal infection (odds ratio, 2.9; 95% confidence interval, 1.1-7.4).


CONCLUSIONS
We conclude that prolonged mechanical ventilation or postnatal infection increases the risk of CLD among surviving preterm infants and that these 2 factors interact with antenatal infection to further increase the risk of CLD.
Van Marter
Linda J
LJ
Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA.
Dammann
Olaf
O
Allred
Elizabeth N
EN
Leviton
Alan
A
Pagano
Marcello
M
Moore
Marianne
M
Martin
Camilia
C
D016022:Case-Control Studies; D002821:Chorioamnionitis / Q000150:complications*; D002908:Chronic Disease; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D007235:Infant, Premature, Diseases / Q000209:etiology*; D008171:Lung Diseases / Q000209:etiology*; D008297:Male; D015999:Multivariate Analysis; D010920:Placenta / Q000382:microbiology; D011247:Pregnancy; D012121:Respiration, Artificial; D018805:Sepsis / Q000150:complications; D014509:Ureaplasma / Q000302:isolation & purification