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Impact of different stages of intrauterine inflammation on outcome of preterm neonates: Gestational age-dependent and -independent effect

OBJECTIVE: To investigate the impact of different stages of intrauterine inflammation (IUI) on neonatal outcomes, before and after adjusting for gestational age (GA) and other perinatal confounders. METHODS: This was an observational, prospective, single-center cohort study including all eligible ne...

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Autores principales: Pietrasanta, Carlo, Pugni, Lorenza, Merlo, Daniela, Acaia, Barbara, Consonni, Dario, Ronchi, Andrea, Ossola, Manuela Wally, Ghirardi, Beatrice, Bottino, Ilaria, Cribiù, Fulvia Milena, Bosari, Silvano, Mosca, Fabio
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Public Library of Science 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6368287/
https://www.ncbi.nlm.nih.gov/pubmed/30735531
http://dx.doi.org/10.1371/journal.pone.0211484
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author Pietrasanta, Carlo
Pugni, Lorenza
Merlo, Daniela
Acaia, Barbara
Consonni, Dario
Ronchi, Andrea
Ossola, Manuela Wally
Ghirardi, Beatrice
Bottino, Ilaria
Cribiù, Fulvia Milena
Bosari, Silvano
Mosca, Fabio
author_facet Pietrasanta, Carlo
Pugni, Lorenza
Merlo, Daniela
Acaia, Barbara
Consonni, Dario
Ronchi, Andrea
Ossola, Manuela Wally
Ghirardi, Beatrice
Bottino, Ilaria
Cribiù, Fulvia Milena
Bosari, Silvano
Mosca, Fabio
author_sort Pietrasanta, Carlo
collection PubMed
description OBJECTIVE: To investigate the impact of different stages of intrauterine inflammation (IUI) on neonatal outcomes, before and after adjusting for gestational age (GA) and other perinatal confounders. METHODS: This was an observational, prospective, single-center cohort study including all eligible neonates with GA < 35 weeks and/or birth weight ≤ 1500 g born at a 3(rd) level Neonatal Intensive Care Unit between 2011 and 2014. Pathological patterns of placenta, membranes and cord were classified according to Redline’s criteria. Multivariable linear and logistic regression models were applied, either including or not GA among the covariates. RESULTS: Of the 807 enrolled neonates, 134 (16.6%) had signs of IUI: among these, 54.5% showed just histological chorioamnionitis (HCA), 25.4% had HCA + funisitis (FUN) stage 1, and 20.1% had HCA + FUN stage 2–3. At univariate analysis, HCA increased the risk for retinopathy of prematurity (ROP) and bronchopulmonary dysplasia, while FUN (any stage) had a deleterious impact on all outcomes investigated. After adjustment for covariates not including GA, HCA was a risk factor only for ROP (OR = 2.8, CI: 1–7.8), while FUN (any stage) was still associated with increased ORs for all outcomes (p <0.01). Upon inclusion of GA in the regression model, the results differed remarkably. HCA was associated with lower risk for mechanical ventilation (OR = 0.3, CI: 0.1–0.7) and need for surfactant (OR = 0.5, CI: 0.2–0.9), while FUN (any stage) worsened clinical conditions at birth (p <0.05), increased the risk for early-onset sepsis (p <0.01), and increased the length of mechanical ventilation (FUN stage 2–3 only, RC = 6.5 days, CI: 2–11). No other outcome was affected. CONCLUSIONS: IUI, especially FUN, negatively impact most neonatal morbidities, but its effect is partially reverted adjusting for GA. Considered that GA is an intermediate variable interposed between prenatal causes of prematurity and outcomes, the appropriateness of adjusting for GA may be questionable.
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spelling pubmed-63682872019-02-22 Impact of different stages of intrauterine inflammation on outcome of preterm neonates: Gestational age-dependent and -independent effect Pietrasanta, Carlo Pugni, Lorenza Merlo, Daniela Acaia, Barbara Consonni, Dario Ronchi, Andrea Ossola, Manuela Wally Ghirardi, Beatrice Bottino, Ilaria Cribiù, Fulvia Milena Bosari, Silvano Mosca, Fabio PLoS One Research Article OBJECTIVE: To investigate the impact of different stages of intrauterine inflammation (IUI) on neonatal outcomes, before and after adjusting for gestational age (GA) and other perinatal confounders. METHODS: This was an observational, prospective, single-center cohort study including all eligible neonates with GA < 35 weeks and/or birth weight ≤ 1500 g born at a 3(rd) level Neonatal Intensive Care Unit between 2011 and 2014. Pathological patterns of placenta, membranes and cord were classified according to Redline’s criteria. Multivariable linear and logistic regression models were applied, either including or not GA among the covariates. RESULTS: Of the 807 enrolled neonates, 134 (16.6%) had signs of IUI: among these, 54.5% showed just histological chorioamnionitis (HCA), 25.4% had HCA + funisitis (FUN) stage 1, and 20.1% had HCA + FUN stage 2–3. At univariate analysis, HCA increased the risk for retinopathy of prematurity (ROP) and bronchopulmonary dysplasia, while FUN (any stage) had a deleterious impact on all outcomes investigated. After adjustment for covariates not including GA, HCA was a risk factor only for ROP (OR = 2.8, CI: 1–7.8), while FUN (any stage) was still associated with increased ORs for all outcomes (p <0.01). Upon inclusion of GA in the regression model, the results differed remarkably. HCA was associated with lower risk for mechanical ventilation (OR = 0.3, CI: 0.1–0.7) and need for surfactant (OR = 0.5, CI: 0.2–0.9), while FUN (any stage) worsened clinical conditions at birth (p <0.05), increased the risk for early-onset sepsis (p <0.01), and increased the length of mechanical ventilation (FUN stage 2–3 only, RC = 6.5 days, CI: 2–11). No other outcome was affected. CONCLUSIONS: IUI, especially FUN, negatively impact most neonatal morbidities, but its effect is partially reverted adjusting for GA. Considered that GA is an intermediate variable interposed between prenatal causes of prematurity and outcomes, the appropriateness of adjusting for GA may be questionable. Public Library of Science 2019-02-08 /pmc/articles/PMC6368287/ /pubmed/30735531 http://dx.doi.org/10.1371/journal.pone.0211484 Text en © 2019 Pietrasanta et al http://creativecommons.org/licenses/by/4.0/ This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/) , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
spellingShingle Research Article
Pietrasanta, Carlo
Pugni, Lorenza
Merlo, Daniela
Acaia, Barbara
Consonni, Dario
Ronchi, Andrea
Ossola, Manuela Wally
Ghirardi, Beatrice
Bottino, Ilaria
Cribiù, Fulvia Milena
Bosari, Silvano
Mosca, Fabio
Impact of different stages of intrauterine inflammation on outcome of preterm neonates: Gestational age-dependent and -independent effect
title Impact of different stages of intrauterine inflammation on outcome of preterm neonates: Gestational age-dependent and -independent effect
title_full Impact of different stages of intrauterine inflammation on outcome of preterm neonates: Gestational age-dependent and -independent effect
title_fullStr Impact of different stages of intrauterine inflammation on outcome of preterm neonates: Gestational age-dependent and -independent effect
title_full_unstemmed Impact of different stages of intrauterine inflammation on outcome of preterm neonates: Gestational age-dependent and -independent effect
title_short Impact of different stages of intrauterine inflammation on outcome of preterm neonates: Gestational age-dependent and -independent effect
title_sort impact of different stages of intrauterine inflammation on outcome of preterm neonates: gestational age-dependent and -independent effect
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6368287/
https://www.ncbi.nlm.nih.gov/pubmed/30735531
http://dx.doi.org/10.1371/journal.pone.0211484
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