Effect of chorioamnionitis on mortality, early onset neonatal sepsis and bronchopulmonary dysplasia in preterm neonates with birth weight of ≤ 1,500 grams [Utjecaj korioamnionitisa na mortalitet, ranu sepsu i bronhopulmonalnu displaziju u nedonoščadi porodne težine ≤1,500 grama ]

Štimac, Maja and Juretić, Emilja and Vukelić, Vesna and Peruško Matasić, Nina and Kos, Marina and Babić, Damir (2014) Effect of chorioamnionitis on mortality, early onset neonatal sepsis and bronchopulmonary dysplasia in preterm neonates with birth weight of ≤ 1,500 grams [Utjecaj korioamnionitisa na mortalitet, ranu sepsu i bronhopulmonalnu displaziju u nedonoščadi porodne težine ≤1,500 grama ]. Collegium Antropologicum, 38 (1). pp. 167-171. ISSN 0350-6134

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Abstract

The aim of the study was to investigate the effects of chorioamnionitis on mortality and early onset neonatal sepsis (EONS) and bronchopulmonary dysplasia (BPD) in preterm neonates with birth weight < or = 1,500 g. The study included 395 preterm infants born at the Zagreb Clinical Hospital Center, from January 2001 to December 2005. All the placentas from preterm deliveries were sent for pathological examination. The patients were categorized into two groups: one including patients with chorioamnionitis at placental histology (47%) and the other control group without chorioamnionitis (53%). Neonates were distributed into 3 groups according to gestational age: the first group with 132 (33%) infants born at < or = 28 weeks of gestation, the second with 202 (52%) infant born from 29 to 32 weeks of gestation and the third with 61 (15%) infants born at > or = 33 weeks gestation. Chorioamnionitis was diagnosed significantly more often in the first gestational age group (91/132-69% of infants, chi2 = 51.307, p < 0.05). The outcome was lethal in 67/395 (17%) patients; 55% of them had chorioamnionitis (chi2 = 2.421, p > 0.05). Lethal outcome ensued in 54/132 (41%) infants from the first gestational age group; 30/54 (55%) were born from pregnancies complicated by chorioamnionitis. In comparison with the control group, mortality was significantly higher in the group of premature infants with gestation < or = 28 weeks whose placentas showed chorioamnionitis (chi2 = 7.645, p < 0.01). EONS was probable or confirmed in 100/395 (25%) infants; in 66/100 (66%) infants pregnancy was complicated by chorioamnionitis (chi2 = 22.396, p < 0.01). BPD developed in 25/395 (6%) infants; in 12/25 (48%) infants placentas showed chorioamnionitis (chi2 = 0.022, p > 0.05). In conclusion, premature neonates from pregnancies complicated by chorioamnionitis are more often born at < or = 28 weeks of gestation. Chorioamnionitis in neonates whose gestation is < or = 28 weeks leads to a significantly higher rate of mortality than in neonates with a longer gestation period. A greater incidence of EONS was proven in the group of infants with chorioamnionitis. The difference between the incidence of BPD in preterm infants born from pregnancies complicated by chorioamnionitis and the control group was not significant.

Abstract in Croatian

Cilj ove retrospektivne studije je istražiti utjecaj korioamnionitisa na mortalitet, ranu novorođenačku sepsu (EONS) i bronhopulmonarnu displaziju (BPD) u nedonoščadi porodne težine ≤1,500 g. U studiju je uključeno 395 nedonoščadi rođenih u Kliničkom bolničkom centru Zagreb, u periodu od siječnja 2001. do prosinca 2005. Ispitanici su podijeljeni u 2 skupine prema nalazu patohistološkog pregleda posteljice, plodovih ovoja i pupkovine: u skupinu čija je trudnoća komplicirana korioamnionitisom i kontrolnu skupinu bez korioamnionitisa. Korioamnionitis je potvrđen u 184 (47%) ispitanih posteljica. Nedonoščad je podijeljena prema gestacijskoj dobi: bilo je 132 (33%) gestacije ≤28 tjedana, 202 (52%) gestacije 29 do 32 tjedna i 61 (15%) gestacije ≥33tjedna. U skupini nedonoščadi s gestacijom ≤28 tjedana bilo je 91/132 (69%) nedonošče rođeno iz trudnoće komplicirane korioamnionitisom (chi2=51,307, p<0,05). Smrtni ishod je uslijedio u 67 (17%) ispitanika, a 37/67 (55%) je bilo u skupini s korioamnionitisom (chi2=2,421, p>0,05). U skupini nedonoščadi čija je gestacija ≤28 tjedana umrlo je 54/132 (41%) ispitanika, a 30/54 (55%) je rođeno iz trudnoće komplicirane korioamnionitisom. Utvrđen je statistički značajno viši mortalitet u skupini nedonoščadi gestacije ≤28 tjedana koja je u trudnoći bila izložena korioamnionitisu (chi2=7,645, p<0,01). EONS je utvrđen u 100 (25%) ispitanika, a 66/100 (66%) je bilo iz skupine čija trudnoća je opterećena korioamnionitisom, što je pokazalo statistički značajnu razliku u odnosu na kontrolnu skupinu (chi2=22,396, p<0.01). BPD je razvijen u 25 (6%) ispitanika, a 12/25 (48%) je pripadalo skupini koja je u trudnoći izložena korioamnionitisu (chi2=0,022, p>0,05). Trudnoće komplicirane korioamnionitisom statistički značajno češće završavaju porodom ≤28 tjedana gestacije. Utvrđen je statistički značajno veći mortalitet u nedonoščadi gestacije ≤28 tjedana ukoliko su bila izložena korioamnionitisu. U skupini nedonoščadi rođenih iz trudnoće s korioamnionitisom je statistički značajno češća pojava EONS-a. Nedonoščad čije su majke u trudnoći imale korioamnionitis nema statistički značajno češću pojavnost BPD-a.

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