title: Association of Chorioamnionitis with Aberrant Neonatal Gut Colonization and Adverse Clinical Outcomes.
abstract: OBJECTIVE
  Chorioamnionitis (inflammation of the placenta and fetal membranes) and abnormal gastrointestinal colonization have been associated with an increased risk of sepsis and death in preterm infants, but whether chorioamnionitis causes abnormal pioneering gastrointestinal colonization in infants is not known. We determined the relationship between chorioamnionitis, altered infant fecal microbiome indicating abnormal gastrointestinal colonization, and adverse outcomes.
  
  
  METHODS
  Preterm infants ≤ 28 weeks at birth were enrolled from 3 level III NICUs in Cincinnati, Ohio and Birmingham, Alabama. Sequencing for 16S microbial gene was performed on stool samples in the first 3 weeks of life. Chorioamnionitis was diagnosed by placental histology. Late onset sepsis and death outcomes were analyzed in relation to fecal microbiota and chorioamnionitis with or without funisitis (inflammation of the umbilical cord).
  
  
  RESULTS
  Of the 106 enrolled infants, 48 infants had no chorioamnionitis, 32 infants had chorioamnionitis but no funisitis (AC), and 26 infants had chorioamnionitis with funisitis (ACF). The fecal samples from ACF infants collected by day of life 7 had higher relative abundance of family Mycoplasmataceae (phylum Tenericutes), genus Prevotella (phylum Bacteroidetes) and genus Sneathia (phylum Fusobacteria). Further, AC and ACF infants had higher incidence of late-onset sepsis/death as a combined outcome. Presence of specific clades in fecal samples, specifically, order Fusobacteria, genus Sneathia or family Mycoplasmataceae, were significantly associated with higher risk of sepsis or death.
  
  
  CONCLUSIONS
  The results support the hypothesis that specific alterations in the pioneering infant gastrointestinal microbiota induced by chorioamnionitis predispose to neonatal sepsis or death.
authors.affiliation: Division of Neonatology and the Perinatal Institute, Cincinnati Children's Hospital Medical Center and the University of Cincinnati, Cincinnati, OH, United States of America.
authors.forename: Kriti
authors.initials: K
authors.lastname: Puri
authors.affiliation: Division of Neonatology and the Perinatal Institute, Cincinnati Children's Hospital Medical Center and the University of Cincinnati, Cincinnati, OH, United States of America.
authors.forename: Diana H
authors.initials: DH
authors.lastname: Taft
authors.affiliation: Division of Neonatology, University of Alabama at Birmingham, Birmingham, AL, United States of America.
authors.forename: Namasivayam
authors.initials: N
authors.lastname: Ambalavanan
authors.affiliation: Division of Neonatology and the Perinatal Institute, Cincinnati Children's Hospital Medical Center and the University of Cincinnati, Cincinnati, OH, United States of America.
authors.forename: Kurt R
authors.initials: KR
authors.lastname: Schibler
authors.affiliation: Division of Neonatology and the Perinatal Institute, Cincinnati Children's Hospital Medical Center and the University of Cincinnati, Cincinnati, OH, United States of America.
authors.forename: Ardythe L
authors.initials: AL
authors.lastname: Morrow
authors.affiliation: Division of Neonatology and the Perinatal Institute, Cincinnati Children's Hospital Medical Center and the University of Cincinnati, Cincinnati, OH, United States of America.
authors.forename: Suhas G
authors.initials: SG
authors.lastname: Kallapur