Effects of Placental Inflammation on Neonatal Outcome in Preterm Infants
Effects of Placental Inflammation on Neonatal Outcome in Preterm Infants
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DOI：
10.1016/j.pedneo.2013.05.007
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发表时间：
2014-02-01
影响因子：
2.1
通讯作者：
Yang, Yi
中科院分区：
文献类型：
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作者：
Liu, Zhiwei;Tang, Zheng;Yang, Yi
背景：宫内感染是早产最常见的原因。在这项研究中，我们的目的是在胎龄小于 34 周的早产儿前瞻性观察队列中确定胎盘炎症与新生儿结局之间的关联。我们特别关注有和没有胎儿炎症反应（FIR）的母体炎症反应（MIR）的不同影响。方法：前瞻性收集216名胎龄小于34周的单胎婴儿的临床特征和胎盘组织学结果。结果：在216名新生儿中，104名（48.1%）婴儿患有组织学胎盘炎症。根据病理结果，将早产儿分为三组：（1）MIR阴性-FIR阴性（MIR-FIR-）组； (2) MIR阳性-FIR阳性(MIR+FIR+)组； (3)MIR正-FIR负(MIR+FIR-)组。 MIR+FIR-组（5.7%）和MIR+FIR+组（2.0%）新生儿呼吸窘迫综合征（RDS）的发生率显着低于MIR-FIR-组（19.6%）（p < 0.05）。 Logistic回归分析显示，MIR+FIR+组新生儿RDS发生率降低（OR = 0.076；95% CI 0.009-0.624；p = 0.016）。 MIR+FIR+ 组 (42.3%) 的 2 级或以上脑室内出血 (IVH) 发生率显着高于 MIR+FIR- 组 (13.0%) (p < 0.05) 或 MIR-FIR- 组 (15.2%) (p < 0.05)。 Logistic 回归分析还显示，MIR+FIR+ 与 2 级或以上 IVH 发生率增加相关（OR = 4.08；95% CI 1.259-13.24；p = 0.019）。结论：MIR 阳性与 FIR 阳性相关可降低 RDS 风险，但会增加胎龄小于 34 周的早产儿发生 2 级或以上 IVH 的风险。然而，单独的 MIR 阳性对新生儿结局影响不大。版权所有 (C) 2013，台湾儿科学会。由爱思唯尔台湾有限公司出版。版权所有。
Background: Intrauterine infection is the most commonly identified cause of preterm birth. In this study, our aim was to determine the association between placental inflammation and neonatal outcome in a prospective observational cohort of preterm infants of less than 34 weeks gestational age. We especially focused on the distinct effects of maternal inflammatory response (MIR) with and without fetal inflammatory response (FIR).Methods: Clinical characteristics and placental histological results were prospectively collected from 216 singleton infants born at a gestational age of less than 34 weeks.Results: Of the 216 newborns, 104 (48.1%) infants had histological placental inflammation. Based on their pathological findings, the premature infants were divided into three groups: (1) the MIR negative-FIR negative (MIR-FIR-) group; (2) the MIR positive-FIR positive (MIR+FIR+) group; and (3) the MIR positive-FIR negative (MIR+FIR-) group. The incidence of neonatal respiratory distress syndrome (RDS) in the MIR+FIR- group (5.7%) and in the MIR+FIR+ group (2.0%) was significantly lower than in the MIR-FIR- group (19.6%) (p < 0.05). Logistic regression analysis showed that MIR+FIR+ group had a decreased incidence of neonatal RDS (OR = 0.076; 95% CI 0.009-0.624; p = 0.016). The incidence of intraventricular hemorrhage (IVH) Grade 2 or greater was significantly higher in the MIR+FIR+ group (42.3%) than in the MIR+FIR- group (13.0%) (p < 0.05) or in the MIR-FIR- group (15.2%) (p < 0.05). Logistic regression analysis also showed that MIR+FIR+ was associated with an increased incidence of IVH Grade 2 or greater (OR = 4.08; 95% CI 1.259-13.24; p = 0.019).Conclusion: A positive MIR in association with a positive FIR decreases the risk of RDS, but increases the risk of IVH Grade 2 or greater in preterm infants with a gestational age of less than 34 weeks. However, a positive MIR alone has little effect on neonatal outcome. Copyright (C) 2013, Taiwan Pediatric Association. Published by Elsevier Taiwan LLC. All rights reserved.