title: Histologic chorioamnionitis: an occult marker of severe pulmonary hypertension in the term newborn.
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 > or =37 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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Pediatrics, UT Southwestern Medical Center, Dallas, TX 75390-9063, USA.
authors.forename: Mesfin
authors.initials: M
authors.lastname: Woldesenbet
authors.forename: Jeffrey M
authors.initials: JM
authors.lastname: Perlman
mesh_terms: D002821:Chorioamnionitis / Q000150:complications* / Q000473:pathology; D015199:Extracorporeal Membrane Oxygenation; D005260:Female; D006612:High-Frequency Ventilation; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D009569:Nitric Oxide / Q000627:therapeutic use; D010547:Persistent Fetal Circulation Syndrome / Q000150:complications* / Q000628:therapy; D011247:Pregnancy; D011446:Prospective Studies; D012189:Retrospective Studies
chemical_list: D009569:Nitric Oxide