Chorioamnionitis and early childhood outcomes among extremely low-gestational-age neonates

Athina Pappas; Douglas E Kendrick; Seetha Shankaran; Barbara J Stoll; Edward F Bell; Abbott R Laptook; Michele C Walsh; Abhik Das; Ellen C Hale; Nancy S Newman; Rosemary D Higgins; Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network

doi:10.1001/jamapediatrics.2013.4248

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Chorioamnionitis and early childhood outcomes among extremely low-gestational-age neonates

Journal article

Open access

Peer reviewed

Chorioamnionitis and early childhood outcomes among extremely low-gestational-age neonates

Athina Pappas, Douglas E Kendrick, Seetha Shankaran, Barbara J Stoll, Edward F Bell, Abbott R Laptook, Michele C Walsh, Abhik Das, Ellen C Hale, Nancy S Newman, …

JAMA pediatrics, Vol.168(2), pp.137-147

02/2014

DOI: 10.1001/jamapediatrics.2013.4248

PMCID: PMC4219500

PMID: 24378638

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Abstract

Chorioamnionitis is strongly linked to preterm birth and neonatal infection. The association between histological and clinical chorioamnionitis and cognitive, behavioral, and neurodevelopmental outcomes among extremely preterm neonates is less clear. We evaluated the impact of chorioamnionitis on 18- to 22-month neurodevelopmental outcomes in a contemporary cohort of extremely preterm neonates. To compare the neonatal and neurodevelopmental outcomes of 3 groups of extremely low-gestational-age infants with increasing exposure to perinatal inflammation: no chorioamnionitis, histological chorioamnionitis alone, or histological plus clinical chorioamnionitis. Longitudinal observational study at 16 centers of the Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network. Two thousand three hundred ninety extremely preterm infants born at less than 27 weeks' gestational age (GA) between January 1, 2006, and December 31, 2008, with placental histopathology and 18 to 22 months' corrected age follow-up data were eligible. Chorioamnionitis. Outcomes included cerebral palsy, gross motor functional limitation, behavioral scores (according to the Brief Infant-Toddler Social and Emotional Assessment), cognitive and language scores (according to the Bayley Scales of Infant and Toddler Development, Third Edition), and composite measures of death/neurodevelopmental impairment. Multivariable logistic and linear regression models were developed to assess the association between chorioamnionitis and outcomes while controlling for important variables known at birth. Neonates exposed to chorioamnionitis had a lower GA and higher rates of early-onset sepsis and severe periventricular-intraventricular hemorrhage as compared with unexposed neonates. In multivariable models evaluating death and neurodevelopmental outcomes, inclusion of GA in the model diminished the association between chorioamnionitis and adverse outcomes. Still, histological plus clinical chorioamnionitis was associated with increased risk of cognitive impairment as compared with no chorioamnionitis (adjusted odds ratio [OR], 2.38 [95% CI, 1.32 to 4.28] without GA; adjusted OR, 2.00 [95% CI, 1.10 to 3.64] with GA as a covariate). Histological chorioamnionitis alone was associated with lower odds of death/neurodevelopmental impairment as compared with histological plus clinical chorioamnionitis (adjusted OR, 0.68 [95% CI, 0.52 to 0.89] without GA; adjusted OR, 0.66 [95% CI, 0.49 to 0.89] with GA as a covariate). Risk of behavioral problems did not differ statistically between groups. Antenatal exposure to chorioamnionitis is associated with altered odds of cognitive impairment and death/neurodevelopmental impairment in extremely preterm infants.

Pregnancy

United States - epidemiology

Chorioamnionitis - epidemiology

Cerebral Palsy - epidemiology

Humans

Risk Factors

Infant

Linear Models

Logistic Models

Male

Gestational Age

Developmental Disabilities - epidemiology

Child Behavior Disorders - epidemiology

Female

Infant, Extremely Premature

Infant, Premature, Diseases - epidemiology

Cognition Disorders - epidemiology

Longitudinal Studies

Details

Title: Subtitle: Chorioamnionitis and early childhood outcomes among extremely low-gestational-age neonates
Creators: Athina Pappas - Department of Pediatrics, Wayne State University, Detroit, Michigan
Douglas E Kendrick - Social, Statistical, and Environmental Sciences Unit, RTI International, Research Triangle Park, North Carolina
Seetha Shankaran - Department of Pediatrics, Wayne State University, Detroit, Michigan
Barbara J Stoll - Department of Pediatrics, Emory University School of Medicine, Children's Healthcare of Atlanta, Atlanta, Georgia
Edward F Bell - Department of Pediatrics, University of Iowa, Iowa City
Abbott R Laptook - Department of Pediatrics, Women & Infants' Hospital, Brown University, Providence, Rhode Island
Michele C Walsh - Department of Pediatrics, Emory University School of Medicine, Children's Healthcare of Atlanta, Atlanta, Georgia
Abhik Das - Social, Statistical, and Environmental Sciences Unit, RTI International, Rockville, Maryland
Ellen C Hale - Department of Pediatrics, Emory University School of Medicine, Children's Healthcare of Atlanta, Atlanta, Georgia
Nancy S Newman - Department of Pediatrics, Rainbow Babies & Children's Hospital, Case Western Reserve University, Cleveland, Ohio
Rosemary D Higgins - Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland
Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network
Resource Type: Journal article
Publication Details: JAMA pediatrics, Vol.168(2), pp.137-147
DOI: 10.1001/jamapediatrics.2013.4248
PMID: 24378638
PMCID: PMC4219500
NLM abbreviation: JAMA Pediatr
ISSN: 2168-6203
eISSN: 2168-6211
Grant note: UG1 HD053089 / NICHD NIH HHS U10 HD27856 / NICHD NIH HHS U10HD36790 / NICHD NIH HHS M01 RR997 / NCRR NIH HHS M01 RR16587 / NCRR NIH HHS U10 HD53089 / NICHD NIH HHS U10 HD027871 / NICHD NIH HHS U10 HD27880 / NICHD NIH HHS M01 RR008084 / NCRR NIH HHS M01 RR016587 / NCRR NIH HHS U10 HD040498 / NICHD NIH HHS U10 HD27904 / NICHD NIH HHS M01 RR000080 / NCRR NIH HHS U10 HD021373 / NICHD NIH HHS U10 HD040492 / NICHD NIH HHS M01 RR39 / NCRR NIH HHS M01 RR000997 / NCRR NIH HHS M01 RR32 / NCRR NIH HHS M01 RR7122 / NCRR NIH HHS U10 HD040521 / NICHD NIH HHS U10 HD27853 / NICHD NIH HHS U10 HD053089 / NICHD NIH HHS M01 RR70 / NCRR NIH HHS U10 HD040689 / NICHD NIH HHS U10 HD027904 / NICHD NIH HHS M01 RR8084 / NCRR NIH HHS UL1 TR001449 / NCATS NIH HHS U10 HD40498 / NICHD NIH HHS UL1 TR000454 / NCATS NIH HHS M01 RR64 / NCRR NIH HHS M01 RR44 / NCRR NIH HHS UL1 RR24139 / NCRR NIH HHS U10 HD40492 / NICHD NIH HHS M01 RR007122 / NCRR NIH HHS U10 HD021385 / NICHD NIH HHS UG1 HD034216 / NICHD NIH HHS U10 HD040461 / NICHD NIH HHS U10 HD53119 / NICHD NIH HHS UG1 HD068278 / NICHD NIH HHS U10 HD053124 / NICHD NIH HHS M01 RR80 / NCRR NIH HHS M01 RR000039 / NCRR NIH HHS M01 RR59 / NCRR NIH HHS U10 HD27851 / NICHD NIH HHS UL1 RR024160 / NCRR NIH HHS M01 RR000125 / NCRR NIH HHS U10 HD053119 / NICHD NIH HHS M01 RR125 / NCRR NIH HHS U10HD34216 / NICHD NIH HHS UL1 RR025764 / NCRR NIH HHS M01 RR000054 / NCRR NIH HHS U10 HD21397 / NICHD NIH HHS UG1 HD053109 / NICHD NIH HHS U10 HD021397 / NICHD NIH HHS U10 HD036790 / NICHD NIH HHS UL1 RR024139 / NCRR NIH HHS UL1 RR24160 / NCRR NIH HHS M01 RR000044 / NCRR NIH HHS U10 HD21364 / NICHD NIH HHS U10 HD053109 / NICHD NIH HHS U10 HD027856 / NICHD NIH HHS M01RR750 / NCRR NIH HHS U10 HD27871 / NICHD NIH HHS U10 HD027880 / NICHD NIH HHS U10 HD027853 / NICHD NIH HHS U10 HD021364 / NICHD NIH HHS U10 HD40689 / NICHD NIH HHS U10 HD027851 / NICHD NIH HHS M01 RR000633 / NCRR NIH HHS U10 HD40461 / NICHD NIH HHS M01 RR000070 / NCRR NIH HHS U10 HD21385 / NICHD NIH HHS M01 RR633 / NCRR NIH HHS UG1 HD087229 / NICHD NIH HHS U10 HD034216 / NICHD NIH HHS U10 HD40521 / NICHD NIH HHS M01 RR000750 / NCRR NIH HHS UL1 RR25764 / NCRR NIH HHS U10 HD21373 / NICHD NIH HHS M01 RR30 / NCRR NIH HHS M01 RR54 / NCRR NIH HHS U10 HD53124 / NICHD NIH HHS
Language: English
Date published: 02/2014
Academic Unit: Stead Family Department of Pediatrics; Neonatology
Record Identifier: 9984093491802771

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