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Intra-Amniotic Inflammation or Infection: Suspected and Confirmed Diagnosis of “Triple I” at Term

Chorioamnionitis (CA) at term of pregnancy can have an infectious and/or inflammatory origin and is associated with adverse outcomes. Triple I (intrauterine inflammation, infection, or both, TI) has been proposed to reduce the overdiagnosis of infection and neonatal overtreatment. The aim of this st...

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Autores principales: Consonni, Sara, Salmoiraghi, Elettra, Vaglio Tessitore, Isadora, Pintucci, Armando, Vitale, Valentina, Calzi, Patrizia, Moltrasio, Francesca, Locatelli, Anna
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10378617/
https://www.ncbi.nlm.nih.gov/pubmed/37508607
http://dx.doi.org/10.3390/children10071110
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author Consonni, Sara
Salmoiraghi, Elettra
Vaglio Tessitore, Isadora
Pintucci, Armando
Vitale, Valentina
Calzi, Patrizia
Moltrasio, Francesca
Locatelli, Anna
author_facet Consonni, Sara
Salmoiraghi, Elettra
Vaglio Tessitore, Isadora
Pintucci, Armando
Vitale, Valentina
Calzi, Patrizia
Moltrasio, Francesca
Locatelli, Anna
author_sort Consonni, Sara
collection PubMed
description Chorioamnionitis (CA) at term of pregnancy can have an infectious and/or inflammatory origin and is associated with adverse outcomes. Triple I (intrauterine inflammation, infection, or both, TI) has been proposed to reduce the overdiagnosis of infection and neonatal overtreatment. The aim of this study is to identify clinical and histological variables that could predict adverse outcomes when TI is suspected and/or confirmed. This retrospective cohort study included 404 pregnancies (gestational age ≥ 37 weeks) that were divided into 5 all-inclusive and mutually exclusive groups. TI was defined according to the NICHD definition of 2015, and it could be confirmed (TI+) or not confirmed (TI−) via histological examination. Signs of infection/inflammation that did not conform to the definition of TI were classified as “clinical suspicion” and could be supported (CS+) or not supported (CS−) by histology. Cases of histological chorioamnionitis (HCA) without clinical manifestation represented a fifth group. Whole placental involvement (WPLI) was defined as a histological inflammation involving the maternal and fetal sides. There were 113 TI+, 30 TI−, 186 CS+, 35 CS−, and 40 isolated HCA cases. WPLI was diagnosed in 133 cases (39.2%). Composite neonatal outcome (CNO) occurred in 114 cases (28.2%) while composite maternal outcome (CMO) occurred in 192 cases (47.5%). Compared with CS+, TI+ was more predictive of CNO (p = 0.001), CMO (p < 0.001), and WPLI (p = 0.005). WPLI was related both to CNO (p < 0.001) and to CMO (p = 0.046). TI+ and WPLI showed similar sensitivity but different specificity in predicting CNO. At logistic regression, CNO was independently predicted by TI+ (OR 2.21; p = 0.001) and by WPLI (OR 2.23; p = 0.001). Compared with CS, TI is a better predictor of CNO and can be useful for the identification of newborns at risk.
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spelling pubmed-103786172023-07-29 Intra-Amniotic Inflammation or Infection: Suspected and Confirmed Diagnosis of “Triple I” at Term Consonni, Sara Salmoiraghi, Elettra Vaglio Tessitore, Isadora Pintucci, Armando Vitale, Valentina Calzi, Patrizia Moltrasio, Francesca Locatelli, Anna Children (Basel) Article Chorioamnionitis (CA) at term of pregnancy can have an infectious and/or inflammatory origin and is associated with adverse outcomes. Triple I (intrauterine inflammation, infection, or both, TI) has been proposed to reduce the overdiagnosis of infection and neonatal overtreatment. The aim of this study is to identify clinical and histological variables that could predict adverse outcomes when TI is suspected and/or confirmed. This retrospective cohort study included 404 pregnancies (gestational age ≥ 37 weeks) that were divided into 5 all-inclusive and mutually exclusive groups. TI was defined according to the NICHD definition of 2015, and it could be confirmed (TI+) or not confirmed (TI−) via histological examination. Signs of infection/inflammation that did not conform to the definition of TI were classified as “clinical suspicion” and could be supported (CS+) or not supported (CS−) by histology. Cases of histological chorioamnionitis (HCA) without clinical manifestation represented a fifth group. Whole placental involvement (WPLI) was defined as a histological inflammation involving the maternal and fetal sides. There were 113 TI+, 30 TI−, 186 CS+, 35 CS−, and 40 isolated HCA cases. WPLI was diagnosed in 133 cases (39.2%). Composite neonatal outcome (CNO) occurred in 114 cases (28.2%) while composite maternal outcome (CMO) occurred in 192 cases (47.5%). Compared with CS+, TI+ was more predictive of CNO (p = 0.001), CMO (p < 0.001), and WPLI (p = 0.005). WPLI was related both to CNO (p < 0.001) and to CMO (p = 0.046). TI+ and WPLI showed similar sensitivity but different specificity in predicting CNO. At logistic regression, CNO was independently predicted by TI+ (OR 2.21; p = 0.001) and by WPLI (OR 2.23; p = 0.001). Compared with CS, TI is a better predictor of CNO and can be useful for the identification of newborns at risk. MDPI 2023-06-26 /pmc/articles/PMC10378617/ /pubmed/37508607 http://dx.doi.org/10.3390/children10071110 Text en © 2023 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Consonni, Sara
Salmoiraghi, Elettra
Vaglio Tessitore, Isadora
Pintucci, Armando
Vitale, Valentina
Calzi, Patrizia
Moltrasio, Francesca
Locatelli, Anna
Intra-Amniotic Inflammation or Infection: Suspected and Confirmed Diagnosis of “Triple I” at Term
title Intra-Amniotic Inflammation or Infection: Suspected and Confirmed Diagnosis of “Triple I” at Term
title_full Intra-Amniotic Inflammation or Infection: Suspected and Confirmed Diagnosis of “Triple I” at Term
title_fullStr Intra-Amniotic Inflammation or Infection: Suspected and Confirmed Diagnosis of “Triple I” at Term
title_full_unstemmed Intra-Amniotic Inflammation or Infection: Suspected and Confirmed Diagnosis of “Triple I” at Term
title_short Intra-Amniotic Inflammation or Infection: Suspected and Confirmed Diagnosis of “Triple I” at Term
title_sort intra-amniotic inflammation or infection: suspected and confirmed diagnosis of “triple i” at term
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10378617/
https://www.ncbi.nlm.nih.gov/pubmed/37508607
http://dx.doi.org/10.3390/children10071110
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