title: Effects of placental inflammation on neonatal outcome in preterm infants.
abstract: BACKGROUND
  Intrauterine infection is the most commonly identified cause of preterm birth. In this study, our aim was to determine the association between placental inflammation and neonatal outcome in a prospective observational cohort of preterm infants of less than 34 weeks gestational age. We especially focused on the distinct effects of maternal inflammatory response (MIR) with and without fetal inflammatory response (FIR).
  
  
  METHODS
  Clinical characteristics and placental histological results were prospectively collected from 216 singleton infants born at a gestational age of less than 34 weeks.
  
  
  RESULTS
  Of the 216 newborns, 104 (48.1%) infants had histological placental inflammation. Based on their pathological findings, the premature infants were divided into three groups: (1) the MIR negative-FIR negative (MIR-FIR-) group; (2) the MIR positive-FIR positive (MIR+FIR+) group; and (3) the MIR positive-FIR negative (MIR+FIR-) group. The incidence of neonatal respiratory distress syndrome (RDS) in the MIR+FIR- group (5.7%) and in the MIR+FIR+ group (2.0%) was significantly lower than in the MIR-FIR- group (19.6%) (p < 0.05). Logistic regression analysis showed that MIR+FIR+ group had a decreased incidence of neonatal RDS (OR = 0.076; 95% CI 0.009-0.624; p = 0.016). The incidence of intraventricular hemorrhage (IVH) Grade 2 or greater was significantly higher in the MIR+FIR+ group (42.3%) than in the MIR+FIR- group (13.0%) (p < 0.05) or in the MIR-FIR- group (15.2%) (p < 0.05). Logistic regression analysis also showed that MIR+FIR+ was associated with an increased incidence of IVH Grade 2 or greater (OR = 4.08; 95% CI 1.259-13.24; p = 0.019).
  
  
  CONCLUSIONS
  A positive MIR in association with a positive FIR decreases the risk of RDS, but increases the risk of IVH Grade 2 or greater in preterm infants with a gestational age of less than 34 weeks. However, a positive MIR alone has little effect on neonatal outcome.
authors.affiliation: Children's Hospital of Fudan University, Key Laboratory of Neonatal Diseases, Ministry of Health, 399 Wanyuan Road, Shanghai 201102, China; International Peace Maternity & Children Hospital of China Welfare Institution, 910 Hengshan Road, Shanghai 20030, China.
authors.forename: Zhiwei
authors.initials: Z
authors.lastname: Liu
authors.affiliation: International Peace Maternity & Children Hospital of China Welfare Institution, 910 Hengshan Road, Shanghai 20030, China.
authors.forename: Zheng
authors.initials: Z
authors.lastname: Tang
authors.affiliation: International Peace Maternity & Children Hospital of China Welfare Institution, 910 Hengshan Road, Shanghai 20030, China.
authors.forename: Juan
authors.initials: J
authors.lastname: Li
authors.affiliation: Children's Hospital of Fudan University, Key Laboratory of Neonatal Diseases, Ministry of Health, 399 Wanyuan Road, Shanghai 201102, China. Electronic address: yyang@shmu.edu.cn.
authors.forename: Yi
authors.initials: Y
authors.lastname: Yang
mesh_terms: D000328:Adult; D002543:Cerebral Hemorrhage / Q000209:etiology*; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D016015:Logistic Models; D010920:Placenta / Q000473:pathology*; D011247:Pregnancy; D047928:Premature Birth / Q000209:etiology; D011446:Prospective Studies; D012127:Respiratory Distress Syndrome, Newborn / Q000209:etiology*
keywords: intraventricular hemorrhage; neonatal outcome; placental inflammation; preterm infants; respiratory distress syndrome