Corioamnionite e lesão pulmonar no recém-nascido de extremo baixo peso

Chorioamnionitis and lung damage in the extremely low birth weight infant

 

Gustavo Rocha¹

Elisa Proença²

Conceição Quintas³

Teresa Rodrigues⁴

Hercília Guimarães⁵

 

Resumo

Alguns estudos experimentais sugerem que a exposição a infecção intra-uterina associa-se, não só, a maturação pulmonar e menor risco de doença das membranas hialinas, mas também a atraso na formação alveolar e maior risco de displasia broncopulmonar. Objectivo: Avaliar a associação entre corioamnionite histológica e lesão pulmonar no recém-nascido pré-termo de extremo baixo peso. Métodos: Estudo retrospectivo em 63 recém-nascidos com peso ao nascimento inferior a 1000 g, apropriados à idade gestacional, nascidos em três centros hospitalares do Norte de Portugal, entre 2001 e 2002. A associação entre corioamnionite histológica e lesão pulmonar (doença das membranas hialinas e displasia broncopulmonar) foi avaliada através do cálculo de odds ratio. Resultados: Em 32 recém-nascidos as mães apresentaram corioamnionite histológica e em 31 a condição não estava presente. A associação entre corioamnionite histológica e doença das membranas hialinas foi OR 0,23 (IC 95% 0,01 – 2,51). A associação entre corioamnionite histológica e displasia broncopulmonar foi OR 1,61 (IC 95% 0,38 – 6,97). A associação entre corioamnionite histológica e displasia broncopulmonar ajustada para a idade gestacional, gestação múltipla e parto por cesariana não foi estatisticamente significativa: OR 2,66 (IC 95% 0,36 – 19,60) para orioamnionite sem funisite ou vasculite e OR 1,68 (IC 95% 0,25 – 11,18) para corioamnionite com funisite e/ou vasculite. Conclusão: Este estudo não nos permitiu confirmar a existência de menor risco de doença das membranas hialinas ou de maior risco de displasia broncopulmonar no recém-nascido pré-termo de extremo baixo peso com corioamnionite histológica.

Palavras-chave: Corioamnionite, displasia broncopulmonar, doença das membranas hialinas.

 

Abstract

Some experimental work suggests that exposure to intrauterine infection is associated, not only, with lung maturation and a reduced risk of respiratory distress syndrome, but also, with delayed alveolarization and increased risk of bronchopulmonary dysplasia. Aim: To evaluate the association between histological chorioamnionitis and lung disease in extremely low birth weight preterm infants. Methods: A retrospective chart review of 63 less than 1000 g birthweight, appropriated for gestational age neonates, delivered at three tertiary medical centers in the north of Portugal, between 2001 and 2002. The association between histological chorioamnionitis and lung damage (respiratory distress syndrome and bronchopulmonary dysplasia) was evaluated through the calculation of crude and adjusted odds ratio. Results: There were 32 newborns from mothers with histological chorioamnionitis and 31 without the condition. The association between histological chorioamnionitis and respiratory distress syndrome was OR 0.23 (95% CI 0.01 – 2.51). The association between chorioamnionitis and bronchopulmonary dysplasia was OR 1.61 (95% CI 0.38 – 6.97). The association between histological chorioamnionitis and bronchopulmonary dysplasia when adjusted for gestational age, multiple birth and C-section revealed no statistical significance: OR 2.66 (95% CI 0.36 – 19.60) for chorioamnionitis without funisitis or vasculitis and OR 1.68 (95% CI 0.25 – 11.18) for funisitis and/or vasculitis. Conclusion: In this study we could not confirm a decreased risk of respiratory distress syndrome nor an increased risk of bronchopulmonary dysplasia in extremely low birth weight preterm neonates with histological chorioamnionitis.

Key-words: Chorioamnionitis, bronchopulmonary dysplasia, respiratory distress syndrome.

 

 

Texto completo disponível apenas em PDF.

Full text only available in PDF format.

 

 

Bibliography

1. Gomez R, Romero R, Edwin SS, David C. Pathogenesis of preterm labor and preterm premature rupture of membranes associated with intra-amniotic infection. Infect Dis Clin North Am 1997; 11:135-76.        [ Links ]

2. Speer CP. Inflammation and bronchopulmonary dysplasia. Semin Neonatol 2003; 8:29-38.

3. Jobe AH, Newnham JP, Willet KE, Sly P, Ervin MG, Bachurski C, et al. Effects of antenatal endotoxin and glucocorticoids on the lungs of preterm lambs. Am J Obstet Gynecol 2000; 182:401-8.

4. Willet KE, Jobe AH, Ikegami M, Newnham J, Brennan S, Sly PD. Antenatal endotoxin and glucocorticoid effects on lung morphometry in preterm lambs. Pediatr Res 2000; 48:782-8.

5. Schmidt B, Cao L, Mackensen-Haen S, Kendziorra H, Klingel K, Speer CP: Chorioamnionitis and inflammation of the fetal lung. Am J Obstet Gynecol 2001; 185:173-7.

6. Murch SH, Costeloe K, Klein NJ, Rees H, McIntosh N, Keeling JW, MacDonald TT: Mucosal tumor necrosis factor-alpha production and extensive disruption of sulphated glycosaminoglycans begin within hours of birth in neonatal respiratory distress syndrome. Pediatr Res 1996; 40:484-9.

7. Hitti J, Krohn MA, Patton DL, Tarczy-Hornoch P, Hillier SL, Cassen EM, Eschenbach DA: Amniotic fluid tumor necrosis factor alpha and the risk of respiratory distress syndrome among preterm infants. Am J Obstet Gynecol 1997; 177: 50-6.

8. Van Marter LJ, Dammann O, Allred EN, Leviton A, Pagano M, Moore M, et al. Chorioamnionitis, mechanical ventilation, and postnatal sepsis as modulators of chronic lung disease in preterm infants. J Pediatr 2002; 140:171-6.

9. Redline RW, Wilson-Costello D, Hack M. Placental and other perinatal risk factors for chronic lung disease in very low birth weight infants. Pediatr Res 2002; 52:713-9.

10. Kent A, Dahlstrom JE. Chorioamnionitis/funisitis and the development of bronchopulmonary dysplasia. J Paediatr Child Health 2004; 40: 356-9.

11. MacDonald H. American Academy of Pediatrics. Committee on Fetus and Newborn . Perinatal Care at the Threshold of Viability. Pediatrics 2002; 110: 1024-7.

12. Ballard JL, Khoury JC, Wedig K, Wang L, Eilers-Walsman BL, Lipp R. New Ballard Score, expanded to include extremely premature infants. J Pediatr 1991; 119:417-23.

13. Alexander GR, Himes JH, Kaufman RB, Mor J, Kogan M. A United States national reference for fetal growth. Obstet Gynecol 1996 ; 87:163-8.

14. Blanc WA. Pathology of the Placenta, Membranes, and Umbilical Cord in Bacterial, Fungal, and Viral Infections in Man. In: Naeye RL, Kissane JM (Eds.). International Academy of Pathology monograph. Perinatal Diseases by 14 authors. Baltimore: Williams and Willkins, 1981.

15. Crowley PA. Antenatal corticosteroid therapy: a meta-analysis of randomized trials, 1972 to 1994. Am J Obstet Gynecol 1995; 173:322-35.

16. Rudolph AJ, Smith CA: Idiopathic respiratory distress syndrome of the newborn. J Pediatr 1960; 57:905-21.

17. Jobe AH, Bancalari E. Bronchopulmonary dysplasia. Am J Respi Crit Care Med 2001; 163:1723-9. 18. Watterberg KL, Scott SM, Naeye RL. Chorioamnionitis, cortisol, and acute lung disease in very low birth weight infants. Pediatrics 1997; 99: E6.

19. Sapolsky R, Rivier C, Yamamoto G, Plotsky P, Vale W. Interleukin-1 stimulates the secretion of hypothalamic corticotropin-releasing factor. Science 1987; 238:522-4.

20. Bernton EW, Beach JE, Holaday JW, Smallridge RC, Fein HG. Release of multiple hormones by a direct action of interleukin-1 on pituitary cells. Science 1987; 238: 519-21.

21. Gross I. Regulation of fetal lung maturation. Am J Physiol 1990; 259: L 337-44.

22. Newnham JP, Moss TJ, Padbury JF, Willet KE, Ikegami M, Ervin MG, Sly P, Jobe A: the interactive effects of endotoxin with prenatal glucocorticoids on short-term lung function in sheep. Am J Obstet Gynecol 2001; 185:190-7.

23. Jobe AH. The new BPD: An arrest of lung development. Pediatr Res 1999; 46: 641-3.

24. Shennan AT, Dunn MS, Ohlsson A, Lennox K, Hoskins EM: Abnormal pulmonary outcomes in premature infants: Prediction from oxygen requirement in the neonatal period. Pediatrics 1988; 82: 527-32.

25. Speer CP. Inflammatory mechanisms in neonatal chronic lung disease. Eur J Pediatr 1999; 158 (suppl 1): 18-22.

26. Yoon BH, Romero R, Jun JK, Park KH, Park JD, Ghezzi F, et al. Amniotic fluid cytokines (interleukin 6, tumour necrosis factor alpha, interleukin 1b, and interleukin 8) and the risk for the development of bronchopulmonary dysplasia. Am J Obstet Gynecol 1997; 177:825-30.

27. Yoon BH, Romero R, Kim KS, Park JS, Ki SH, Kim BI, et al. A systemic fetal inflammatory response and the development of bronchopulmonary dysplasia. Am J Obstet Gynecol 1999; 181:773-9.

28. Groneck P, Schmale J, Soditt V, Stutzer H, Gotze-Speer B, Speer CP. Bronchoalveolar inflammation following airway infection in preterm infants with chronic lung disease. Pediatr Pulmonol 2001; 31:331-8.

29. Ohyama M, Itani Y, Yamanaka M, Goto A, Kato K, Ijiri R, et al. Re-evaluation of chorioamnionitis and funisitis with a special reference to subacute chorioamnionitis. Hum Pathol 2002; 33:183-90.

30. Dammann O, Leviton A, Bartels DB, Dammann CE. Lung and brain damage in preterm newborns. Are they related? How? Why? Biol Neonate 2004; 85:305-13. 31. Matsuda T, Nakajima T, Hattori S, Hanatani K, Fukazawa Y, Kosayashi K, Fujimoto S. Necrotizing funisitis: Clinical significance and association with chronic lung disease in premature infants. Am J Obstet Gynecol 1997; 177:1402-7.

32. Viscardi RM, Muhumuza CK, Rodriguez A, Fairchild KD, Sun CC, Gross GW, et al. Inflammatory markers in intrauterine and fetal blood and cerebrospinal fluid compartments are associated with adverse pulmonary and neurologic outcomes in preterm infants. Pediatr Res 2004; 55:1009-17.

 

¹Assistente Hospitalar. Pediatric Department, Division of Neonatology, Hospital de São João, University Hospital

²Assistente Hospitalar. Pediatric Department, Maternidade Júlio Dinis

³Assistente Hospitalar. Pediatric Department, Division of Neonatology, Centro Hospitalar de Vila Nova de Gaia

⁴Assistente Hospitalar. Obstetrics and Gynecology Department, Epidemiology Department, Hospital de São João, University Hospital

⁵Chefe de Serviço. Pediatric Department, Division of Neonatology, Hospital de São João, University Hospital

 

Correspondência / Correspondence:

Gustavo Rocha

Serviço de Neonatologia / Departamento de Pediatria

Hospital de São João – Piso 2

Alameda Prof. Hernâni Monteiro

4202 – 451 Porto

Portugal

Tel: +351 225095816

Fax: +351225512273

E-mail: gusrocha@oninet.pt

 

Recebido para publicação/received for publication: 06.02.10

Aceite para publicação/accepted for publication: 07.03.26