Abstract
Echolucent images (EL) of cerebral white matter, seen on cranial ultrasonographic scans of very low birth weight newborns, predict motor and cognitive limitations. We tested the hypothesis that markers of maternal and feto-placental infection were associated with risks of both early (diagnosed at a median age of 7 d) and late (median age = 21 d) EL in a multi-center cohort of 1078 infants <1500 ×g. Maternal infection was indicated by fever, leukocytosis, and receipt of antibiotic; feto-placental inflammation was indicated by the presence of fetal vasculitis (i.e. of the placental chorionic plate or the umbilical cord). The effect of membrane inflammation was also assessed. All analyses were performed separately in infants born within 1 h of membrane rupture (n= 537), or after a longer interval (n= 541), to determine whether infection markers have different effects in infants who are unlikely to have experienced ascending amniotic sac infection as a consequence of membrane rupture. Placental membrane inflammation by itself was not associated with risk of EL at any time. The risks of both early and late EL were substantially increased in infants with fetal vasculitis, but the association with early EL was found only in infants born ≥1 after membrane rupture and who had membrane inflammation (adjusted OR not calculable), whereas the association of fetal vasculitis with late EL was seen only in infants born <1 h after membrane rupture (OR = 10.8;p= 0.05). Maternal receipt of antibiotic in the 24 h just before delivery was associated with late EL only if delivery occurred <1 h after membrane rupture (OR = 6.9;p= 0.01). Indicators of maternal infection and of a fetal inflammatory response are strongly and independently associated with EL, particularly late EL.
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Abbreviations
- EL:
-
echolucency in cerebral white matter
- OR:
-
odds ratio
- VLBWI:
-
very low birth weight infants
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Acknowledgements
The authors thank the women who not only agreed to be interviewed for this study, but also allowed data to be collected from their babies' charts. The authors express their appreciation to their colleagues who contributed to the success of this project.
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Supported by the National Institute of Neurologic Disorders and Stroke (NS 27306) and from a grant provided by United Cerebral Palsy Research and Education Foundation (R-712–96).
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Leviton, A., Paneth, N., Reuss, M. et al. Maternal Infection, Fetal Inflammatory Response, and Brain Damage in Very Low Birth Weight Infants. Pediatr Res 46, 566 (1999). https://doi.org/10.1203/00006450-199911000-00013
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DOI: https://doi.org/10.1203/00006450-199911000-00013
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