Maternal Chorioamnionitis and Hypoxic-Ischemic Encephalopathy: The MATCH Study

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PROJECT SUMMARY Hypoxic-ischemic encephalopathy (HIE) is a severe neurologic syndrome affecting more than 12,000 newborns in the United States each year. HIE results in death or neurodevelopmental disabilities in about half of affected neonates. The causes of HIE are heterogeneous and poorly understood. Chorioamnionitis, or intrauterine infection/inflammation, gives rise to a fetal inflammatory response syndrome that may reduce a fetus’ ability to tolerate hypoxia-ischemia during delivery. Chorioamnionitis has been associated with a 4-fold increased risk of HIE, and may also reduce the efficacy of therapeutic hypothermia, the only available therapy for HIE. However, chorioamnionitis is an imprecise clinical diagnosis that refers to a spectrum of conditions. Clinical evidence of inflammation (“clinical chorioamnionitis”) during labor and delivery relies on the presence of maternal fever which is non-specific. Fever occurs in 5% of laboring mothers and can be caused by other factors such as epidural analgesia. A better understanding of the relationship between chorioamnionitis, maternal fever and HIE is crucial to improving our ability to prevent and treat HIE. A recent NICHD consensus report recommended a more precise definition of clinical chorioamnionitis (“Chorio-NICHD”) based on specific cut-offs for maternal temperature, maternal white cell count, and fetal tachycardia. But how Chorio-NICHD relates to HIE risk is unknown. Whether the presence of Chorio-NICHD reduces the neuroprotective effect of therapeutic hypothermia has also not been studied. To fill these gaps in knowledge, I will test the hypothesis that Chorio-NICHD is independently associated with a higher risk of HIE in the child, and is associated with increased risk of HIE brain injury despite treatment with therapeutic hypothermia. By leveraging a large birth cohort with rich data spanning perinatal, neonatal, and childhood periods, I will: 1. Quantify the association between Chorio-NICHD, including clinical features such as height and duration of maternal fever, degree of leukocytosis, and degree of fetal tachycardia, and HIE. 2. Determine if chorioamnionitis defined by clinical or histologic criteria is associated with severity of MRI brain injury in neonates with HIE treated with therapeutic hypothermia. 3. Quantify the association between Chorio- NICHD and childhood neurodevelopmental impairment. As a neonatologist and clinical researcher, my career objective is to become an independent physician-epidemiologist generating actionable evidence that optimizes diagnosis and treatment of neonatal brain disorders. With this K23, I will pursue advanced training in neonatal brain disease epidemiology, develop skills in electronic health data management and longitudinal data analyses. I will receive training in the analysis of neonatal brain MRI findings and placental histology. This career award, with its rigorous training program and outstanding mentorship team, will allow me to become a leader in the field of neonatal neurology and an independent physician-scientist. In years 4-5 of this award, I will be poised to submit an R01 to study novel strategies for preventing and treating neonates with HIE in the setting of intrauterine inflammation. 1