Chorioamnionitis, respiratory distress syndrome and bronchopulmonary dysplasia in extremely low birth weight infants.
OBJECTIVE
To determine if histologic chorioamnionitis (HC) in the presence of respiratory distress syndrome (RDS) augments adverse pulmonary outcomes in extremely low birth weight (ELBW) infants.


METHODS
We retrospectively identified 184 ELBW infants who were born at and admitted to the neonatal intensive care units between June 2005 and June 2009.


RESULTS
The mean gestational age of the cases was 27 ± 2 weeks, and the mean birth weight was 791 ± 147 g. A total of 88% (161/184) of patients developed bronchopulmonary dysplasia (BPD). HC was observed in 71 of 238 infants (39%). When infants were divided on the basis of the presence or absence of HC and RDS, the incidence of moderate or severe BPD and duration of oxygen requirement were greater in the HC+RDS+ group than in the HC-RDS+ or HC+RDS- groups. The combination of prenatal (HC) and postnatal (RDS) injuries increased significantly the risk for BPD. In the multivariate analysis, the significant predictors of developing BPD were low gestational age (odds ratio (OR), 0.6; confidence interval (CI), 0.4 to 0.7) and exposure to both HC and RDS (OR, 4.7; CI, 1.1 to 20.2).


CONCLUSIONS
The HC and RDS work synergistically to induce lung injury in ELBW infants. Chorioamnionitis may interact with RDS to further increase the risk of BPD, despite either HC or RDS could not show independent significant association with BPD.
Lee
Hyun Ju
HJ
Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea.
Kim
Ee-Kyung
EK
Kim
Han-Suk
HS
Choi
Chang Won
CW
Kim
Beyong Ii
BI
Choi
Jung-Hwan
JH
D001997:Bronchopulmonary Dysplasia / Q000150:complications*; D002821:Chorioamnionitis; D005260:Female; D005865:Gestational Age; D006801:Humans; D052577:Infant, Extremely Low Birth Weight; D007231:Infant, Newborn; D008297:Male; D011247:Pregnancy; D011248:Pregnancy Complications; D012127:Respiratory Distress Syndrome, Newborn / Q000150:complications*; D012189:Retrospective Studies; D012307:Risk Factors