title: Fetal inflammation associated with minimal acute morbidity in moderate/late preterm infants.
abstract: OBJECTIVE
  To determine whether exposure to acute chorioamnionitis and fetal inflammation caused short-term adverse outcomes.
  
  
  METHODS
  This is a prospective observational study: subjects were mothers delivering at 32-36 weeks gestation and their preterm infants at a large urban tertiary level III perinatal unit (N=477 infants). Placentae and fetal membranes were scored for acute histological chorioamnionitis based on the Redline criteria. Fetal inflammation was characterised by histological diagnosis of funisitis (umbilical cord inflammation), increased cord blood cytokines measured by ELISA, and activation of the inflammatory cells infiltrating the placenta and fetal membranes measured by immunohistology. Maternal and infant data were collected.
  
  
  RESULTS
  Twenty-four per cent of 32-36-week infants were exposed to histological chorioamnionitis and 6.9% had funisitis. Immunostaining for leucocyte subsets showed selective infiltration of the placenta and fetal membranes with activated neutrophils and macrophages with chorioamnionitis. Interleukin (IL) 6, IL-8 and granulocyte colony-stimulating factor were selectively increased in the cord blood of preterm infants with funisitis. Compared with infants without chorioamnionitis, funisitis was associated with increased ventilation support during resuscitation (43.8% vs 15.4%) and more respiratory distress syndrome postnatally (27.3% vs 10.2%) in univariate analysis. However, these associations disappeared after adjusting for prematurity.
  
  
  CONCLUSIONS
  Despite fetal exposure to funisitis, increased cord blood cytokines and activated placental inflammatory cells, we could not demonstrate neonatal morbidity specifically attributable to fetal inflammation after adjusting for gestational age in moderate and late preterm infants.
authors.affiliation: Divisions of Neonatology and Pulmonary Biology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.|Division of Neonatology, University of Minnesota, Minneapolis, Minnesota, USA.
authors.forename: Tate
authors.initials: T
authors.lastname: Gisslen
authors.affiliation: Divisions of Neonatology and Pulmonary Biology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.
authors.forename: Manuel
authors.initials: M
authors.lastname: Alvarez
authors.affiliation: Department of Immunobiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.
authors.forename: Casey
authors.initials: C
authors.lastname: Wells
authors.affiliation: Divisions of Neonatology and Pulmonary Biology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.|Department of Pediatrics, Kwong Wah Hospital, Hong Kong, Hong Kong.
authors.forename: Man-Ting
authors.initials: MT
authors.lastname: Soo
authors.affiliation: Department of Obstetrics and Gynecology, Good Samaritan Hospital, Cincinnati, Ohio, USA.
authors.forename: Donna S
authors.initials: DS
authors.lastname: Lambers
authors.affiliation: Institute of Health and Biomedical Innovation, Faculty of Health, Queensland University of Technology, Brisbane, Australia.
authors.forename: Christine L
authors.initials: CL
authors.lastname: Knox
authors.affiliation: Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.
authors.forename: Jareen K
authors.initials: JK
authors.lastname: Meinzen-Derr
authors.affiliation: Department of Immunobiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.
authors.forename: Claire A
authors.initials: CA
authors.lastname: Chougnet
authors.affiliation: Divisions of Neonatology and Pulmonary Biology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.
authors.forename: Alan H
authors.initials: AH
authors.lastname: Jobe
authors.affiliation: Divisions of Neonatology and Pulmonary Biology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.
authors.forename: Suhas G
authors.initials: SG
authors.lastname: Kallapur
keywords: Fetal Medicine; Immunology; Neonatology; Resuscitation