PEDIATRICS Vol. 97 No. 2 February 1996, pp. 210-215
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Chorioamnionitis and Early Lung Inflammation in Infants in Whom Bronchopulmonary Dysplasia Develops

Kristi L. Watterberg MD1, Laurence M. Demers PhD2, Susan M. Scott MD3, and Shirley Murphy MD3

1 The Department of Pediatrics, Milton S. Hershey Medical Center, Pennsylvania State University, Hershey
2 The Department of Pathology, Milton S. Hershey Medical Center, Pennsylvania State University, Hershey
3 The Department of Pediatrics, Children's Hospital of New Mexico, University of New Mexico School of Medicine, Albuquerque.

Objective. The development of bronchopulmonary dysplasia (BPD) often has been attributed to injury from mechanical ventilation and supplemental oxygen. Early lung inflammation in infants with BPD has been thought to be secondary to these factors. The purpose of this study was to evaluate whether preexisting (prenatal) inflammation may be a primary causative factor in the development of BPD.

Methods. Intubated newborns of less than 2000 g birth weight were prospectively enrolled. The presence or absence of chorioamnionitis was documented. Lung inflammation was evaluated on days 1, 2, and 4 of intubation by assaying concentrations of interleukin 1beta(IL-1beta), thromboxane B2, leukotriene B4, and prostaglandin E2 in tracheal lavages. Infants in whom BPD developed were compared with those in whom it did not using these measures.

Results. Fifty-three infants were enrolled; 41 survived. Thirty-eight had respiratory distress syndrome; 15 were intubated for other diagnoses. Infants prenatally exposed to chorioamnionitis were less likely to present with respiratory distress syndrome; however, chorioamnionitis was significantly associated with both the presence of IL-1beta from the first day of intubation and the development of BPD. Tracheal lavage concentrations of IL-1beta were higher in infants in whom BPD developed. Thromboxane B2 concentrations were similar on day 1 but were higher on days 2 and 4 in infants in whom BPD developed.

Conclusions. In this study, intubated infants weighing less than 2000 g at birth in whom BPD developed had increased exposure to inflammation prenatally (chorioamnionitis) and evidence of increased lung inflammation from the first postnatal day. We speculate that chorioamnionitis may accelerate lung maturation but that it also causes lung inflammation and subsequent lung injury in intubated infants, fostering the development of BPD.

Key Words: chorioamnionitis • bronchopulmonary dysplasia • newborn • thromboxane B2 leukotriene B4 interleukin 1beta • prostaglandin E2 • respiratory distress syndrome • lung lavage fluid

Submitted on December 19, 1994
Accepted on April 7, 1995




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