Chorioamnionitis alters the response to surfactant in preterm infants.

Abstract

OBJECTIVE:

To study the association between antenatal exposure to chorioamnionitis and the neonatal response to surfactant.

STUDY DESIGN:

Prospective observational cohort of 301 preterm infants of gestational age < or = 32.0 weeks, 146 of whom received surfactant according to standardized criteria. Fraction of inspired oxygen (FiO(2)) requirement (using analysis of variance) and time to extubation (using Kaplan-Meier and Cox regression analyses) were compared between groups based on the presence of histological chorioamnionitis (HC) with or without fetal involvement (HC-, n = 88; HC + F-, n = 25; HC + F+, n = 33) and between infants who developed bronchopulmonary dysplasia (BPD) or died (n = 57) and BPD-free survivors (n = 89). Multiple logistic regression was performed to investigate the association between HC and BPD.

RESULTS:

Compared with HC- infants, HC + F+ infants had significantly greater FiO(2) requirement and prolonged time to extubation postsurfactant, not accounted for by differences in gestational age and birth weight. Infants with BPD/death had a strikingly similar pattern of increased FiO(2) requirement postsurfactant. Moreover, in infants who received surfactant, HC + F+ status was associated with increased risk for BPD (odds ratio [OR] = 3.40; 95% confidence interval [CI] = 1.02-11.3; P = .047) and for BPD/death (OR = 2.72; 95% CI = 1.00-7.42; P = .049).

CONCLUSIONS:

An impaired surfactant response was observed in preterm infants with severe chorioamnionitis and may be involved in the association between chorioamnionitis, mechanical ventilation, and the development of BPD.

• Authors: Jasper V Been, Ingrid G Rours, René F Kornelisse, Femke Jonkers, Ronald R de Krijger, Luc J Zimmermann
• Journal: The Journal of pediatrics (J Pediatr) Vol. 156 Issue 1 Pg. 10-15.e1 (Jan 2010) ISSN: 1097-6833 [Electronic] United States
• PMID: 19833352 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)

Chemical References

• Biological Products
• Pulmonary Surfactants
• beractant

Topics

• Adult
• Biological Products (therapeutic use)
• Bronchopulmonary Dysplasia (epidemiology, prevention & control)
• Chorioamnionitis (epidemiology)
• Comorbidity
• Female
• Humans
• Infant, Newborn
• Infant, Premature
• Logistic Models
• Pregnancy
• Prospective Studies
• Pulmonary Surfactants (therapeutic use)
• Respiration, Artificial
• Respiratory Distress Syndrome, Newborn (epidemiology)