title: Chorioamnionitis alters the response to surfactant in preterm infants.
abstract: OBJECTIVE
  To study the association between antenatal exposure to chorioamnionitis and the neonatal response to surfactant.
  
  
  METHODS
  Prospective observational cohort of 301 preterm infants of gestational age < or = 32.0 weeks, 146 of whom received surfactant according to standardized criteria. Fraction of inspired oxygen (FiO(2)) requirement (using analysis of variance) and time to extubation (using Kaplan-Meier and Cox regression analyses) were compared between groups based on the presence of histological chorioamnionitis (HC) with or without fetal involvement (HC-, n = 88; HC + F-, n = 25; HC + F+, n = 33) and between infants who developed bronchopulmonary dysplasia (BPD) or died (n = 57) and BPD-free survivors (n = 89). Multiple logistic regression was performed to investigate the association between HC and BPD.
  
  
  RESULTS
  Compared with HC- infants, HC + F+ infants had significantly greater FiO(2) requirement and prolonged time to extubation postsurfactant, not accounted for by differences in gestational age and birth weight. Infants with BPD/death had a strikingly similar pattern of increased FiO(2) requirement postsurfactant. Moreover, in infants who received surfactant, HC + F+ status was associated with increased risk for BPD (odds ratio [OR] = 3.40; 95% confidence interval [CI] = 1.02-11.3; P = .047) and for BPD/death (OR = 2.72; 95% CI = 1.00-7.42; P = .049).
  
  
  CONCLUSIONS
  An impaired surfactant response was observed in preterm infants with severe chorioamnionitis and may be involved in the association between chorioamnionitis, mechanical ventilation, and the development of BPD.
authors.affiliation: Department of Paediatrics, School for Oncology and Developmental Biology (GROW), Maastricht University Medical Centre, Maastricht, The Netherlands. jasper.been@mumc.nl
authors.forename: Jasper V
authors.initials: JV
authors.lastname: Been
authors.forename: Ingrid G
authors.initials: IG
authors.lastname: Rours
authors.forename: René F
authors.initials: RF
authors.lastname: Kornelisse
authors.forename: Femke
authors.initials: F
authors.lastname: Jonkers
authors.forename: Ronald R
authors.initials: RR
authors.lastname: de Krijger
authors.forename: Luc J
authors.initials: LJ
authors.lastname: Zimmermann
mesh_terms: D000328:Adult; D001688:Biological Products / Q000627:therapeutic use*; D001997:Bronchopulmonary Dysplasia / Q000453:epidemiology / Q000517:prevention & control; D002821:Chorioamnionitis / Q000453:epidemiology*; D015897:Comorbidity; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D016015:Logistic Models; D011247:Pregnancy; D011446:Prospective Studies; D011663:Pulmonary Surfactants / Q000627:therapeutic use*; D012121:Respiration, Artificial; D012127:Respiratory Distress Syndrome, Newborn / Q000453:epidemiology*
chemical_list: D001688:Biological Products; D011663:Pulmonary Surfactants; C072197:beractant