Published online April 27, 2009
PEDIATRICS Vol. 123 No. 5 May 2009, pp. 1314-1319 (doi:10.1542/peds.2008-0656)
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ARTICLE

Intrauterine Inflammation, Neonatal Sepsis, and Chronic Lung Disease: A 13-Year Hospital Cohort Study

Monica M. Lahra, BA, MB BS, PhD, FRCPA, Philip J. Beeby, BSc, MB BS, PhD, FRACP and Heather E. Jeffery, MB BS, PhD, MPH, FRACP

Department of Neonatal Medicine, Royal Prince Alfred Hospital, New South Wales, Australia; Department of Medicine, University of Sydney, New South Wales, Australia

OBJECTIVE. To determine the impact of intrauterine inflammation of maternal (chorioamnionitis) and fetal (umbilical vasculitis) origin and neonatal sepsis on the development of neonatal chronic lung disease in preterm infants.

METHODS. This study was conducted at Royal Prince Alfred Hospital in Sydney, Australia. All infants born at <30 weeks' gestation, admitted to the NICU, and surviving to 36 weeks' corrected gestation during 1992–2004 were eligible. Infants with major congenital abnormalities and those without placental examination were excluded. Antenatal and perinatal data extracted from hospital databases were correlated with the independent, central neonatal database and diagnostic laboratory reports. Neonatal sepsis was categorized according to blood culture isolates into 3 groups: coagulase-negative staphylococci, other bacteria, and Candida species.

RESULTS. There were 798 eligible infants born during the study period, and 761 (95.4%) had placental examination. The mean gestational age was 27.4 ± 1.5 weeks. Antenatal maternal steroids were given to 94.4%. Regression analysis showed that chorioamnionitis with umbilical vasculitis and increasing gestation were associated with reduced odds of chronic lung disease. Chorioamnionitis without umbilical vasculitis showed a trend to reduced odds of chronic lung disease. Birth weight at <3rd percentile and neonatal sepsis were associated with increased odds of chronic lung disease.

CONCLUSIONS. A fetal inflammatory response is protective for chronic lung disease. Neonatal sepsis is strongly associated with chronic lung disease, and the infecting organism is important. Coagulase-negative staphylococcal infection confers a risk for chronic lung disease similar to that of other bacteremias. Candidemia confers the greatest risk of chronic lung disease.

Key Words: chorioamnionitis • umbilical vasculitis • fetal inflammatory response • chronic lung disease • neonatal sepsis

Abbreviations: CLD—chronic lung disease • RDS—respiratory distress syndrome • RPAH—Royal Prince Alfred Hospital • NICUS—New South Wales NICU Study • OR—odds ratio • aOR—adjusted odds ratio • CI—confidence interval

Accepted Aug 29, 2008.


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eLetters:

Read all eLetters

Chorioamnionitis and chronic lung disease in preterm infants
Jasper V. Been, et al.
Pediatrics Online, 24 May 2009 [Full text]
Author's Response
Monica M Lahra, et al.
Pediatrics Online, 1 Jul 2009 [Full text]
Infections w coagulase-negative staphylococci & chronic lung disease in very-low-birth-weight infant
Dr. Christoph Härtel
Pediatrics Online, 6 Jul 2009 [Full text]