The Relationship between Histological Chorioamnionitis and Bronchopulmonary Dysplasia in Low-Birth Weight Infants: Changes of C-Reactive Protein in Bron chopulmonary Dysplasia

Kyungju Kim; Ji Won Jang; Ji Hyeon Moon; Jeonghee Shin; Eun Hee Lee; Byung Min Choi; Young Sook Hong; Min Jeong Oh

doi:10.14734/PN.2019.30.1.8

Journal List > Perinatology > v.30(1) > 1127209

Go to TopGo to Top Go to BottomGo to Bottom

TOOLS

Kim, Jang, Moon, Shin, Lee, Choi, Hong, and Oh: The Relationship between Histological Chorioamnionitis and Bronchopulmonary Dysplasia in Low-Birth Weight Infants: Changes of C-Reactive Protein in Bron chopulmonary Dysplasia

Original Article

Perinatology 2019;30(1):8-13.

Published online: 20 March 2019

DOI: https://doi.org/10.14734/PN.2019.30.1.8

The Relationship between Histological Chorioamnionitis and Bronchopulmonary Dysplasia in Low-Birth Weight Infants: Changes of C-Reactive Protein in Bron chopulmonary Dysplasia

Kyungju Kim, MD¹, Ji Won Jang, MD¹, Ji Hyeon Moon, MD¹, Jeonghee Shin, MD¹, Eun Hee Lee, MD¹, Byung Min Choi, MD, PhD¹, Young Sook Hong, MD, PhD^1,, Min Jeong Oh, MD, PhD²

¹Department of Pediatrics, Seoul, Korea

²Obstetrics and Gynecology, Korea University College of Medicine, Seoul, Korea

Correspondence to Young Sook Hong, MD, PhD Department of Pediatrics, Korea University College of Medicine, 148 Gurodong-gil, Guro-gu, Seoul 08308, Korea Tel: +82-2-2626-1229 Fax: +82-2-2626-1249 E-mail: hongys@korea.ac.kr

Received 3 August 2018 Revised 16 September 2018 Accepted 13 October 2018

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Objective

Intrauterine inflammation caused by chorioamnionitis has been related with various perinatal morbidities which increase the risk of bronchopulmonary dysplasia (BPD). C-reactive protein (CRP) is a well known biomarker of inflammation. We aimed to investigate the relationship between histological chorioamnionitis (HCA) and BPD, and also to observe the changes of CRP in BPD.

Methods

Low-birth-weight infants (LBWIs) admitted to the neonatal intensive care unit between January 2011 and October 2017 were reviewed. Perinatal morbidities associated with BPD including maternal HCA were observed. Also, changes of CRP were analyzed.

Results

A total of 584 LBWIs were analyzed and 168 (28.8%) had HCA and 46 (7.9%) had BPD. The development of BPD was associated with gestational age, birth weight, 1 and 5 minutes Apgar scores, the presence of preterm premature rupture of membrane, prenatal antibiotics, respiratory distress syndrome (RDS), ventilator application, early onset sepsis, necrotizing enterocolitis, intraventricular hemorrhage, retinopathy of prematurity, patent ductus arteriosus and HCA. The multiple logistic regression model for BPD showed that the risk factors of BPD were lower gestational age, lower birth weight, patent ductus arteriosus (PDA). Chorioamnionitis was not a significant risk factor for BPD (aOR, 1.477; 95% CI, 0.376–5.806). Infants with BPD were likely to have higher CRP on day 0 and day 7.

Conclusion

Our study suggests that the primary risk factors of BPD in LBWIs are lower gestational age, lower birth weight, RDS, ventilator application and PDA rather than HCA. In infants with BPD, CRP was significantly higher on day 0 and day 7.

Keywords: Chorioamnionitis, Bronchopulmonary dysplasia, C-reactive protein, Inflammation

References

1. Speer CP. Inflammation and bronchopulmonary dysplasia: a continuing story. Semin Fetal Neonatal Med. 2006; 11:354–62.

2. Kim CJ, Romero R, Chaemsaithong P, Chaiyasit N, Yoon BH, Kim YM. Acute chorioamnionitis and funisitis: definition, pathologic features, and clinical significance. Am J Obstet Gynecol. 2015; 213(4 Suppl):S29–52.

3. Malavolti AM, Bassler D, Arlettaz-Mieth R, Faldella G, Latal B, Natalucci G. Bronchopulmonary dysplasia-impact of severity and timing of diagnosis on neurodevelopment of preterm infants: a retrospective cohort study. BMJ Paediatr Open. 2018; 2:e000165.

4. You JY, Shu C, Gong CH, Liu S, Fu Z. Readmission of children with bronchopulmonary dysplasia in the first 2 years of life: a clinical analysis of 121 cases. Zhongguo Dang Dai Er Ke Za Zhi. 2017; 19:1056–60.

5. Bozzetto S, Carraro S, Tomasi L, Berardi M, Zanconato S, Baraldi E. Health-related quality of life in adolescent survivors of bronchopulmonary dysplasia. Respirology. 2016; 21:1113–7.

6. Redline RW. Classification of placental lesions. Am J Obstet Gynecol. 2015; 213(4 Suppl):S21–8.

7. Gravett MG, Hitti J, Hess DL, Eschenbach DA. Intrauterine infection and preterm delivery: evidence for activation of the fetal hypothalamic-pituitary-adrenal axis. Am J Obstet Gynecol. 2000; 182:1404–13.

8. Balany J, Bhandari V. Understanding the impact of infection, inflammation, and their persistence in the pathogenesis of bronchopulmonary dysplasia. Front Med (Lausanne). 2015; 2:90.

9. Eriksson L, Haglund B, Odlind V, Altman M, Ewald U, Kieler H. Perinatal conditions related to growth restriction and inflammation are associated with an increased risk of bronchopulmonary dysplasia. Acta Paediatr. 2015; 104:259–63.

10. Stranak Z, Feyereisl J, Korcek P, Feyereislova S, Krofta L. Procalcitonin is more likely to be released by the fetus rather than placental tissue during chorioamnionitis. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub. 2016; 160:499–502.

11. Torchin H, Lorthe E, Goffinet F, Kayem G, Subtil D, Truffert P, et al. Histologic chorioamnionitis and bronchopulmonary dysplasia in preterm infants: the epidemiologic study on low gestational ages 2 cohort. J Pediatr. 2017; 187:98–104.e3.

12. Matsumura H, Ichiba H, Ohnishi S, Saito M, Shintaku H. Histologic chorioamnionitis, amniotic fluid interleukin 6, krebs von den lungen 6, and transforming growth factor β1 for the development of neonatal bronchopulmonary dysplasia. Jpn Clin Med. 2017; 8:1179066017696076.

13. Kaneko M, Sato M, Ogasawara K, Imamura T, Hashimoto K, Momoi N, et al. Serum cytokine concentrations, chorioamnionitis and the onset of bronchopulmonary dysplasia in premature infants. J Neonatal Perinatal Med. 2017; 10:147–55.

14. Samejima T, Takechi K. Elevated C-reactive protein levels in histological chorioamnionitis at term: impact of funisitis on term neonates. J Matern Fetal Neonatal Med. 2017; 30:1428–33.

15. Jobe AH, Bancalari E. Bronchopulmonary dysplasia. Am J Respir Crit Care Med. 2001; 163:1723–9.

16. Salafia CM, Weigl C, Silberman L. The prevalence and distribution of acute placental inflammation in uncomplicated term pregnancies. Obstet Gynecol. 1989; 73:383–9.

17. Stoll BJ, Hansen NI, Bell EF, Shankaran S, Laptook AR, Walsh MC, et al. Neonatal outcomes of extremely preterm infants from the NICHD Neonatal Research Network. Pediatrics. 2010; 126:443–56.

18. Palta M, Gabbert D, Weinstein MR, Peters ME. Multivariate assessment of traditional risk factors for chronic lung disease in very low birth weight neonates. The Newborn Lung Project. J Pediatr. 1991; 119:285–92.

19. Yu KH, Li J, Snyder M, Shaw GM, O'Brodovich HM. The genetic predisposition to bronchopulmonary dysplasia. Curr Opin Pediatr. 2016; 28:318–23.

20. Ali Z, Schmidt P, Dodd J, Jeppesen DL. Bronchopulmonary dysplasia: a review. Arch Gynecol Obstet. 2013; 288:325–33.

21. Glaser K, Speer CP. Pre and Postnatal inflammation in the pathogenesis of bronchopulmonary dysplasia, in Bronchopulmonary Dysplasia, edited by Bhandari V, Cham. Springer International Publishing;2016. p.p. 55–77.

22. Viscardi RM. Perinatal inflammation and lung injury. Semin Fetal Neonatal Med. 2012; 17:30–5.

23. Speer CP. Chorioamnionitis, postnatal factors and proinflammatory response in the pathogenetic sequence of bronchopulmonary dysplasia. Neonatology. 2009; 95:353–61.

24. Palmsten K, Nelson KK, Laurent LC, Park S, Chambers CD, Parast MM. Subclinical and clinical chorioamnionitis, fetal vasculitis, and risk for preterm birth: a cohort study. Placenta. 2018; 67:54–60.

25. Watterberg KL, Demers LM, Scott SM, Murphy S. Chorioamnionitis and early lung inflammation in infants in whom bronchopulmonary dysplasia develops. Pediatrics. 1996; 97:210–5.

26. Yoon BH, Romero R, Jun JK, Park KH, Park JD, Ghezzi F, et al. Amniotic fluid cytokines (interleukin-6, tumor necrosis factor-alpha, interleukin-1 beta, and interleukin-8) and the risk for the development of bronchopulmonary dysplasia. Am J Obstet Gynecol. 1997; 177:825–30.

27. Hartling L, Liang Y, Lacaze-Masmonteil T. Chorioamnionitis as a risk factor for bronchopulmonary dysplasia: a systematic review and metaanalysis. Arch Dis Child Fetal Neonatal Ed. 2012; 97:F8–17.

28. Kramer BW, Kallapur S, Newnham J, Jobe AH. Prenatal inflammation and lung development. Semin Fetal Neonatal Med. 2009; 14:2–7.

29. Kramer BW, Ladenburger A, Kunzmann S, Speer CP, Been JV, van Iwa-arden JF, et al. Intravenous lipopolysaccharide-induced pulmonary maturation and structural changes in fetal sheep. Am J Obstet Gynecol. 2009; 200:195e1–10.

30. Thomas W, Speer CP. Chorioamnionitis: important risk factor or innocent bystander for neonatal outcome? Neonatology. 2011; 99:177–87.

31. Choi CW, Lee J, Oh JY, Lee SH, Lee HJ, Kim BI. Protective effect of chorioamnionitis on the development of bronchopulmonary dysplasia triggered by postnatal systemic inflammation in neonatal rats. Pediatr Res. 2016; 79:287–94.

32. Paananen R, Husa AK, Vuolteenaho R, Herva R, Kaukola T, Hallman M. Blood cytokines during the perinatal period in very preterm infants: relationship of inflammatory response and bronchopulmonary dysplasia. J Pediatr. 2009; 154:39–43.e3.

33. Plakkal N, Soraisham AS, Trevenen C, Freiheit EA, Sauve R. Histological chorioamnionitis and bronchopulmonary dysplasia: a retrospective cohort study. J Perinatol. 2013; 33:441–5.

34. Ballard AR, Mallett LH, Pruszynski JE, Cantey JB. Chorioamnionitis and subsequent bronchopulmonary dysplasia in very-low-birth weight infants: a 25-year cohort. J Perinatol. 2016; 36:1045–8.

35. Stimac M, Juretić E, Vukelić V, Matasić NP, Kos M, Babić D. Effect of chorioamnionitis on mortality, early onset neonatal sepsis and bronchopulmonary dysplasia in preterm neonates with birth weight of <1,500 grams. Coll Antropol. 2014; 38:167–71.

36. Choi CW. Chorioamnionitis: is a major player in the development of bronchopulmonary dysplasia? Korean J Pediatr. 2017; 60:203–7.

37. Ansar W, Ghosh S. C-reactive protein and the biology of disease. Immunol Res. 2013; 56:131–42.

38. Lee J, Bang YH, Lee EH, Choi BM, Hong YS. The influencing factors on procalcitonin values in newborns with noninfectious conditions during the first week of life. Korean J Pediatr. 2017; 60:10–6.

39. Chiesa C, Signore F, Assumma M, Buffone E, Tramontozzi P, Osborn JF, et al. Serial measurements of C-reactive protein and interleukin-6 in the immediate postnatal period: reference intervals and analysis of maternal and perinatal confounders. Clin Chem. 2001; 47:1016–22.

40. Chiesa C, Natale F, Pascone R, Osborn JF, Pacifico L, Bonci E, et al. C reactive protein and procalcitonin: reference intervals for preterm and term newborns during the early neonatal period. Clin Chim Acta. 2011; 412:1053–9.

Table 1.

Demographic and Clinical Findings in Low-birth-weight In fants with and without Histological Chorioamnionitis

	HCA	No HCA	P-value
N	168 (28.8)	416 (71.2)
Gestational age (weeks)	32.7±3.7	34.4±2.94	<0.001
<28	21 (12.5)	13 (3.1)	<0.001
28–31	33 (19.6)	52 (12.5)	0.027
≥32	114 (67.9)	351 (84.4)	0.016
Birth weight (g)	1,767±499	1,953±464	<0.001
Male sex	81 (48.2)	199 (47.8)	0.934
Cesarean section	94 (56.0)	303 (72.8)	<0.001
Apgar, 1 minute	6.3±2.47	6.7±2.01	0.059
Apgar, 5 minutes	8.3±1.71	8.6±1.45	0.069
PROM (>18 hours)	56 (33.3)	72 (17.3)	<0.001
GDM	26 (15.7)	75 (18.0)	0.460
Early onset sepsis	3 (1.8)	4 (1.0)	0.415
Ventilator application	67 (39.9)	106 (25.5)	0.001
RDS	50 (29.8)	54 (13.0)	<0.001
IVH	36 (21.4)	51 (12.3)	0.005
BPD	25 (14.9)	21 (5.0)	<0.001
Mild	11 (6.5)	3 (0.7)	<0.001
Moderate to severe	14 (8.3)	18 (4.3)	0.054
Gestational age (weeks)
<28	19 (76.0)	12 (57.2)	0.174
28–31	6 (24.0)	7 (33.3)	0.484
≥32	0 (0.0)	2 (9.5)	0.203
PDA	51 (30.4)	93 (22.4)	0.042

Values are presented as mean±standard deviation or number (%). Abbreviations: HCA, histological chorioamnionitis; PROM, premature rupture o membrane; GDM, gestational diabetes mellitus; RDS, respiratory distress synd rome; IVH, intraventricular hemorrhage; BPD, bronchopulmonary dysplasia; PDA patent ductus arteriosus.

Table 2.

Multiple Logistic Regression for Bronchopulmonary Dysplasia

Variable	OR (95% CI)	P-value	Adjusted OR (95% CI)	P-value
Gestational age (weeks)	0.376 (0.291–0.487)	<0.001	0.659 (0.439–0.989)	0.044
Birth weight (g)	0.995 (0.993–0.996)	<0.001	0.996 (0.993–0.999)	0.004
Apgar, 1 minute	0.507 (0.429–0.599)	<0.001	0.666 (0.430–1.031)	0.069
Apgar, 5 minutes	0.410 (0.327–0.514)	<0.001	1.239 (0.730–2.102)	0.428
PROM	3.105 (1.637–5.889)	0.001	2.334 (0.469–11.614)	0.300
Prenatal antibiotics	4.110 (2.016–8.379)	<0.001	1.915 (0.400–9.175)	0.416
Early onset sepsis	17.398 (3.766–80.370)	<0.001	0.142 (0.012–1.629)	0.117
NEC	4.800 (1.985–11.606)	<0.001	0.133 (0.020–0.889)	0.037
IVH	3.919 (2.048–7.502)	<0.001	2.475 (0.550–11.136)	0.238
ROP	74.525 (32.144–172.784)	<0.001	1.133 (0.230–5.577)	0.878
PDA	19.358 (8.773–42.717)	<0.001	4.259 (1.082–16.767)	0.038
HCA	3.288 (1.785–6.057)	<0.001	1.477 (0.376–5.806)	0.419
Day 7 CRP (mg/dL)	1.057 (1.011–1.105)	0.014	1.081 (1.020–1.145)	0.009

Abbreviations: OR, odds ratio; CI, confidence interval; PROM, premature rupture of membrane; NEC, necrotizing enterocolitis; IVH, intraventricular hemorrhage; ROP, retin-

Table 3.

Comparison of C-reactive Protein Levels according to th Presence of Bronchopulmonary Dysplasia

	BPD	No BPD	P-valu
CRP (mg/dL)
Day 0	0.15 (0.10–0.32) (n=46)	0.13 (0.10–0.20) (n=522)	0.027
Day 3	1.59 (0.68–4.78) (n=45)	1.12 (0.55–2.75) (n=498)	0.072
Day 7	0.57 (0.34–1.79) (n=39)	0.30 (0.18–0.62) (n=455)	<0.001

Values are presented as median (25–75th interquartile). Abbreviations: BPD, bronchopulmonary dysplasia; CRP, C-reactive protein.

TOOLS

Similar articles