Exposure to Intrauterine Inflammation Is Associated with an Increased Need for Resuscitation at Birth

BACKGROUND: Intrauterine inflammation (chorioamnionitis, funisitis) is the leading cause of very preterm delivery. Several studies have been performed to assess a gestation-independent effect of intrauterine inflammation on neonatal outcome with variable results. OBJECTIVE: To evaluate whether histological chorioamnionitis (HCA) and funisitis make neonatal outcome worse. DESIGN/METHODS: We enrolled all infants with birth GA < 35 wks admitted to our NICU during a 12-months period. HCA and funisitis were diagnosed according to Redline's criteria. Infants were stratified into 3 groups: exposed to HCA, exposed to both HCA and funisitis, not exposed to intrauterine inflammation. We collected the following data: oxygen in the delivery room, Apgar score, ventilation, surfactant doses, sepsis, PDA, IVH, BPD, ROP and death. Univariable and multivariable random intercept linear and logistic models were used to evaluate the relationship between the extent of inflammation and outcomes, adjusting for GA, BW, preeclampsia and SGA. RESULTS: Of the 248 neonates enrolled, 39 (15.7%) were exposed to HCA (mean GA 31.6, mean BW 1453.8), 16 (6.5%) were exposed to both HCA and funisitis (mean GA 28.7, mean BW 1417.1), 193 (77.8%) were not exposed to intrauterine inflammation (mean GA 31.9, mean BW 1661.4). In univariable analysis, infants exposed to both HCA and funisitis had significantly lower Apgar score at 1 and 5 min, increased need for oxygen in the delivery room, increased need for surfactant therapy, a higher incidence of IVH, PDA and death than infants in the control group (p < .05 for all variables). No significant differences were found between the infants exposed only to HCA and the control group. In multivariable regression analysis, funisitis was an independent risk factor for a lower Apgar score at 1 min (RC -1.5; 95% CI: -2.4 - -0.6, P = .002) and 5 min (RC -1.2; 95% CI: -1.8 - -0.6, p < .001), and for an increased need for oxygen in the delivery room (OR 12.2; 95% CI: 1.5-19.9, p = .02). CONCLUSIONS: The presence of funisitis was strongly associated with an increased need for resuscitation in the delivery room, independently of GA. This finding, which is not emphasized by many Authors, suggests that when the umbilical cord vessels are involved in inflammation the preterm baby is very ill at birth and this can seriously worsen its outcome.