Abstract
Background
Late-onset sepsis is an important cause of mortality and morbidity in preterm infants. As these infants rely mostly on their innate immune system to fight off infection, enhancing this immune system by appropriate stimuli may prevent late-onset sepsis. However, it remains unclear which stimuli can enhance the neonatal immune system. This study aims to investigate the influence of intrauterine inflammation on late-onset sepsis.
Methods
This is a retrospective cohort study in a Neonatal Intensive Care Unit in the Netherlands. Between 2005 and 2016, 1014 infants with ≤32 weeks gestational age and/or with a birth weight ≤1500 g were included. Intrauterine inflammation was subdivided into histological chorioamnionitis, fetal inflammatory response, and funisitis. Logistic and Cox regression analyses were performed to investigate the influence of intrauterine inflammation on late-onset sepsis.
Results
Thirty-six percent of the included infants developed late-onset sepsis; 24% of placentas showed intrauterine inflammation. Late-onset sepsis incidence did not differ between infants with or without exposure to intrauterine inflammation after adjustment for gestational age (histological chorioamnionitis aHR 0.928 [CI: 0.727–1.185], p = 0.551; fetal inflammatory response aHR 1.011 [CI: 0.793–1.288], p = 0.930); funisitis aHR 0.965 [CI: 0.738–1.263], p = 0.797).
Conclusions
Late-onset sepsis in very preterm infants seems not to be associated with intrauterine inflammation.
Impact
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Intrauterine inflammation is not protective of developing late-onset sepsis in premature infants.
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A large cohort study on the effect of intrauterine inflammation on neonatal outcome.
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This study adds to existing knowledge on finding appropriate stimuli to enhance the immune system of premature infants to improve neonatal outcome.
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Acknowledgements
We would like to thank O. Tjoa and T. Knol for assisting in the completion of the database and C.F. Peeters for support on statistical analyses. Furthermore, we thank the staff of the Department of Neonatology and the Department of Pathology of the VUmc for their assistance in the logistics of this study.
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All authors contributed to the study design and interpretation of the data. M.B.v.D. completed the database, assisted in analysis of placental pathology, performed statistical analyses, drafted the manuscript, and revised it before final approval. J.P.v.d.V. analyzed placental pathology and revised and approved the final version before publication. D.H.V. contributed significantly to the conception of the design of the research, the interpretation of the results, and revising the manuscript before publication. M.M.v.W. contributed to the study design, interpretation of the results, and revision of the manuscript before publication. H.L.T. revised the manuscript and contributed to the interpretation of the results.
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van Doorn, M.B., van der Voorn, J.P., Tanger, H.L. et al. Exposure to intrauterine inflammation and late-onset sepsis in very preterm infants. Pediatr Res 91, 230–234 (2022). https://doi.org/10.1038/s41390-021-01455-0
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DOI: https://doi.org/10.1038/s41390-021-01455-0
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