title: Is there a stepwise increase in neonatal morbidities according to histological stage (or grade) of acute chorioamnionitis and funisitis?: effect of gestational age at delivery.
abstract: OBJECTIVE
  To test if there is a stepwise difference in neonatal outcomes according to the stage (or grade) of histological inflammatory response in the chorioamniotic membranes and umbilical cords of preterm premature rupture of membranes (PPROM).
  
  
  METHODS
  This retrospective study included singleton pregnancies diagnosed as PPROM and delivered prior to 34 weeks of gestation (n=339). Acute histological chorioamnionitis and funisitis were subdivided into stages (or grade) as defined by Redline et al. Neonatal composite morbidities and mortality were also monitored. Univariate and multivariate analyses were conducted.
  
  
  RESULTS
  Increasing stage (or grade) of acute histological chorioamnionitis and funisitis was significantly associated with an earlier gestational age at membrane rupture and delivery. Among neonatal outcomes, respiratory distress syndrome (RDS), bronchopulmonary dysplasia (BPD), intraventricular hemorrhage, retinopathy of prematurity, and composite morbidity showed incremental incidence according to increased stage (or grade) of acute chorioamnionitis, while periventricular leukomalacia and necrotizing enterocolitis did not. Only RDS, BPD, and composite morbidity showed similar incremental incidences associated with severity of funisitis stage. However, the incremental trends of each neonatal outcome were found to be nonsignificant by multivariate analysis adjusting confounding variables including gestational age at delivery.
  
  
  CONCLUSIONS
  Higher incidences of neonatal morbidity according to increased stage (or grade) of either acute histological chorioamnionitis or funisitis were due to an earlier gestational age at delivery.
authors.forename: Yeri
authors.initials: Y
authors.lastname: Lee
authors.forename: Hyun-Joo
authors.initials: HJ
authors.lastname: Kim
authors.forename: Suk-Joo
authors.initials: SJ
authors.lastname: Choi
authors.forename: Soo-Young
authors.initials: SY
authors.lastname: Oh
authors.forename: Jung-Sun
authors.initials: JS
authors.lastname: Kim
authors.forename: Cheong-Rae
authors.initials: CR
authors.lastname: Roh
authors.forename: Jong-Hwa
authors.initials: JH
authors.lastname: Kim
mesh_terms: D000328:Adult; D002821:Chorioamnionitis / Q000453:epidemiology* / Q000473:pathology; D005260:Female; D005322:Premature Rupture of Fetal Membranes / Q000453:epidemiology* / Q000473:pathology; D005865:Gestational Age; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D009017:Morbidity; D010920:Placenta / Q000473:pathology*; D011247:Pregnancy; D056910:Republic of Korea / Q000453:epidemiology; D012189:Retrospective Studies; D012720:Severity of Illness Index; D014470:Umbilical Cord / Q000473:pathology*