The importance of intra-amniotic inflammation in the subsequent development of atypical chronic lung disease.
OBJECTIVE
To examine whether the intra-amniotic inflammation is a risk factor for the development of atypical chronic lung disease (CLD).


METHODS
A retrospective cohort study was undertaken in 72 patients who delivered preterm neonates (gestational age: 24-32 weeks) within 5 days of amniocentesis and whose neonates subsequently developed CLD. Atypical CLD was defined as CLD without respiratory distress syndrome (RDS). Intra-amniotic inflammation was defined as an elevated amniotic fluid (AF) concentration of matrix metalloproteinase-8 (MMP-8) (>23 ng/ml).


RESULTS
(1) Atypical CLD was identified in 54.2% (39/72) of cases with CLD; (2) there were no significant differences in the median gestational age at birth and the rate of antenatal corticosteroid use between infants with atypical CLD and CLD with RDS; (3) preterm newborns with atypical CLD had a significantly higher median AF MMP-8 concentration (median 373.1 ng/ml vs. 8.6 ng/ml, p = 0.003) and median AF white blood cell count (median 450.0/mm(3)vs. 5.5/mm(3), p = 0.009), and a higher rate of intra-amniotic inflammation (74.4%vs. 45.5%, p = 0.012) than those with CLD with RDS.


CONCLUSIONS
Intra-amniotic inflammation confers a greater risk for atypical CLD than for typical CLD with initial RDS. This novel observation strengthens the importance of prenatal inflammation as a mechanism of lung injury.
Lee
Joonho
J
Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul 110-744, Korea.
Oh
Kyung Joon
KJ
Yang
Hye Jin
HJ
Park
Joong Shin
JS
Romero
Roberto
R
Yoon
Bo Hyun
BH
D000328:Adult; D002821:Chorioamnionitis / Q000453:epidemiology; D002908:Chronic Disease; D015331:Cohort Studies; D005260:Female; D005322:Premature Rupture of Fetal Membranes / Q000453:epidemiology; D006801:Humans; D007231:Infant, Newborn; D007235:Infant, Premature, Diseases / Q000453:epidemiology / Q000209:etiology; D007249:Inflammation / Q000150:complications / Q000453:epidemiology; D008171:Lung Diseases / Q000151:congenital* / Q000453:epidemiology / Q000209:etiology*; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000453:epidemiology; D047928:Premature Birth / Q000453:epidemiology / Q000209:etiology; D012189:Retrospective Studies; D055815:Young Adult