649 - Chorioamnionitis is associated with elevated pro-inflammatory cytokines and neonatal morbidities including chronic lung disease and retinopathy of prematurity
Saturday, April 29, 2023
3:30 PM – 6:00 PM ET
Poster Number: 649 Publication Number: 649.24
Jaimie E. Wardinger, Penn State Children's Hospital, HARRISBURG, PA, United States; Fumiyuki C. Gardner, Penn State College of Medicine, Hershey, PA, United States; Brittany J. Fronheiser, Pennsylvania State University College of Medicine, Camp Hill, PA, United States; Kim K. Doheny, Penn State Health Children's Hospital and Penn State College of Medicine, Hershey, PA, United States
NICU fellow Penn State Children's Hospital HARRISBURG, Pennsylvania, United States
Background: Evidence indicates fetuses may experience inflammation in-utero that can linger after birth leading to sustained inflammation and poor outcomes. One mechanism that may lead to sustained neonatal inflammation is via chorioamnionitis. Chorioamnionitis (CA) can be defined clinically or by histopathology with increasing stage indicating higher severity. Elevated levels of inflammation can lead to neonatal morbidities such as chronic lung disease (CLD) and retinopathy of prematurity (ROP); however, the associations between CA and these neonatal outcomes have yet to be established. Objective: To test the hypotheses: a) neonates born to mothers with CA will have younger post-menstrual ages (PMA) at birth and elevated pro-inflammatory cytokines, b) CA will be associated with morbidities including the development of CLD and of ROP. Design/Methods: In this secondary analysis, a prospective cohort of 147 preterm [M(SD) = 31(2.2) weeks’ PMA] neonates were studied. Clinical chorioamnionitis (CCA), as reported in maternal electronic medical records (EMRs), was staged according to the Gibbs classification system using fever, tachycardia, uterine tenderness, and white blood cell count. Histopathologic chorioamnionitis (HCA) was diagnosed based on placental pathology reports. Blood samples for inflammatory cytokines were obtained within the first 5-7 days of life and analyzed using Meso Scale Discovery V-Plex Custom Panel. EMRs were reviewed weekly for clinical outcomes. Results: Of the 144 neonates with CA data, 27 of their mothers (19%) had CCA and/or HCA. Twelve neonates (8%) had funisitis, and three neonates’ mothers (2%) had CCA. Higher HCA staging was associated with younger PMA at birth (p< 0.01). Additionally, higher HCA staging and CCA were associated with higher neonatal IL-1β, IL-8, and TNFα (p< 0.05). CCA/HCA was associated with CLD (p=0.02) and higher staging of ROP (p=0.046). Moreover, neonates with CLD had higher IL-1β and IL-8 vs those who did not have CLD (p=0.045 and p=0.002).
Conclusion(s): In support of our hypotheses, neonates born to mothers who had CA at the time of delivery were born at younger gestations and had higher levels of pro-inflammatory cytokines, inferring that the severity of CA contributed to premature birth and sustained inflammation. Additionally, CA was associated with neonatal morbidities as demonstrated by the development of CLD and ROP. Further studies are necessary to elucidate the mediational pathway between CA, neonatal cytokines, and clinical outcomes.
