CLINICAL CHORIOAMNIONITIS AND THE PROGNOSIS FOR VERY-LOW-BIRTH-WEIGHTINFANTS

Objective: To determine the effects of clinical chorioamnianitis on ne onatal morbidity and mortality in very low birth weight infants. Metho ds: This was an observational cohort analysis of all singleton live-bo rn infants weighing 500-1500 g at 24 weeks' or greater gestational age and born between 1988 and 1996 at Parkland Memorial Hospital, Dallas, Texas. Chorioamnionitis was diagnosed on the basis of maternal fever of 38C with supporting clinical evidence, which included fetal tachyca rdia, uterine tenderness, and/or malodorous infant, and the absence of another source of infection. Multiple logistic regression analysis wa s used to adjust for outcomes of interest. Results: Ninety-five of 136 7 very low birth weight infants (7%) were exposed to chorioamnionitis. Neonatal sepsis, respiratory distress syndrome, seizure in the first 24 hours of life, intraventricular hemorrhage (grade 3 or 4), and peri ventricular leukomalacia were all significantly increased with chorioa mnionitis, after adjusting for preterm ruptured membranes, pregnancy-a ssociated hypertension, cesarean birth, gestational age, and birth wei ght. The odds ratios for intraventricular hemorrhage, periventricular leukomalacia, and seizures in the first 24 hours were 2.8 (95% confide nce interval [CI] 1.6, 4.8), 3.4 (95% CI 1.6, 7.3), and 2.9 (95% CI 1. 2, 6.8), respectively. Conclusion: Our results suggest a link between clinical chorioamnionitis and several indices of neonatal morbidity in the very low birth weight infant. Chorioamnionitis appears to make th e very low birth weight infant particularly vulnerable to neurologic d amage. (C) 1998 by The American College of Obstetricians and Gynecolog ists.