Neonatal outcome of preterm infants born to mothers with abnormal genital tract colonisation and chorioamnionitis: A cohort study
ABSTRACT PURPOSE: We hypothesised that abnormal genital tract colonisation leading to an in utero inflammation/infection process, contributes to the risk of respiratory distress syndrome (RDS), patent ductus arteriosus (PDA), intra ventricular haemorrhage (IVH), bronchopulmonary dysplasia (BPD), retinopathy of prematurity (ROP) and necrotizing enterocolitis (NEC) in preterm infants. METHODS: 396 placentas and umbilical cords of neonates born at 22-32weeks of gestation were evaluated. Genital tract and amniotic fluid swabs were cultured for aerobic and anaerobic bacteria. RESULTS: Chorioamnionitis significantly increases the risk for RDS (OR 1.74, 95% CI 1.14-2.65), NEC (OR 3.22, 95% CI 1.36-3.28) and ROP>2 (OR 2.12, 95% CI 1.33-3.36). But the risk for IVH, PDA and BPD did not differ between the groups. Klebsiella pneumoniae (OR 5.33, 95% CI 1.06-26.79), Staphylococcus sp. (OR 18.39, 95% CI 2.32-145.2) and Enterococcus faecalis (OR 10.7, 95% CI 1.27-89.9) showed a significant relationship with intrauterine inflammation processes. E. faecalis increased the risk for NEC (OR 6.13, 95% CI 1.059-37.6). We did not note a link between ROP and genital tract colonisation. Interestingly PDA seems to be triggered by the presence of Pseudomonas aeruginosa (OR 2.38 95% CI 1.83-3.82). CONCLUSION: Our results show a link between K. pneumoniae, Staphylococcus sp., E. faecalis and intrauterine infection. E. faecalis increases the risk for NEC, and suggests a direct link between gram + bacteria, chorioamnionitis and NEC.
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ABSTRACT: Development of necrotizing enterocolitis (NEC) requires a susceptible host, typically a premature infant or an infant with congenital heart disease, enteral feedings and bacterial colonization. Although there is little doubt that microbes are critically involved in the pathogenesis of NEC, the identity of specific causative pathogens remains elusive. Unlike established normal adult gut microbiota, which is quite complex, uniform, and stable, early postnatal bacterial populations are simple, diverse, and fluid. These properties complicate studies aimed at elucidating characteristics of the gut microbiome that may play a role in the pathogenesis of NEC. A broad variety of bacterial, viral, and fungal species have been implicated in both clinical and experimental NEC. Frequently, however, the same species have also been found in physiologically matched healthy individuals. Clustered outbreaks of NEC, in which the same strain of a suspected pathogen is detected in several patients suggest, but do not prove, a causative relationship between the specific pathogen and the disease. Studies in Cronobacter sakazakii, the best characterized NEC pathogen, have demonstrated that virulence is not a property of a bacterial species as a whole, but rather a characteristic of certain strains, which may explain why the same species can be pathogenic or non-pathogenic. The fact that a given microbe may be innocuous in a full-term, yet pathogenic in a pre-term infant has led to the idea of opportunistic pathogens in NEC. Progress in understanding the infectious nature of NEC may require identifying specific pathogenic strains and unambiguously establishing their virulence in animal models.Seminars in Pediatric Surgery 05/2013; 22(2):69-75. DOI:10.1053/j.sempedsurg.2013.01.002 · 1.94 Impact Factor
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ABSTRACT: Abstract Background and objectives: Chorioamnionitis is an acute inflammation of the membranes and chorion of the placenta. The aim of this study was to determine the effect of histological chorioamnionitis on the short-term outcome of preterm infants. Subjects and methods: The clinical characteristics and outcomes of the preterm infant including respiratory distress syndrome, duration of mechanical ventilation, patent ductus arteriosus requiring medical treatment or ligation, necrotizing enterocolitis, bronchopulmonary dysplasia, death and intraventricular hemorrhage (grade III-IV) were analyzed. Results: Two hundred and eighty-one infants born at ≤32 weeks gestational ages were included. Infants were divided into two groups: one with histological chorioamnionitis (n=145) and without histological chorioamnionitis (n=136). Mean gestational age was 28.8±2.6 weeks and 29.1±2.5 weeks, and mean birth weight was 1138±350 g and 1210±299 g, respectively. There were no differences in gestational age and birth weight among the groups. Compared with the group, histological chorioamnionitis was associated with early onset sepsis (p=0.007), patent ductus arteriosus (p=0.003), intraventricular hemorrhage (p=0.03), and death (p=0.04). Conclusion: Maternal histological chorioamnionitis is an important risk factor for preterm deliveries and associated with serious morbidities such as early onset sepsis, intraventricular hemorrhage, patent ductus arteriosus and increased mortality.The journal of maternal-fetal & neonatal medicine: the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians 10/2013; 27(11). DOI:10.3109/14767058.2013.850668 · 1.21 Impact Factor
- Paediatric Respiratory Reviews 11/2013; DOI:10.1016/j.prrv.2013.09.003 · 2.22 Impact Factor