Chorioamnionitis and the prognosis for term infants

Objective: To assess the effects of clinical chorioamnionitis and labor com plications on short-term neonatal morbidity, including seizures. Methods: This was a retrospective cohort study of all live-born term infant s who weighed more than 2500 g delivered between 1988 and 1997 at Parkland Memorial Hospital, Dallas, Texas. Infant outcomes were compared between wom en with and without clinical diagnoses of chorioamnionitis. Chorioamnioniti s was based on maternal fever of 38C Dr greater with supporting clinical ev idence including fetal tachycardia, uterine tenderness, and malodorous infa nt. Results: A total of 101,170 term infants were analyzed, 5144 (5%) of whom w ere born to women with chorioamnionitis. Apgar scores of 3 or less at 5 min utes, umbilical artery pH of 7.0 or less, delivery-room intubation, sepsis, pneumonia, seizures in the first 24 hours, and meconium aspiration syndrom e were all increased in infants exposed to chorioamnionitis. After adjustme nt for confounding factors, including route of delivery and length of labor , chorioamnionitis remained significantly associated with intubation in the delivery room (odds ratio [OR] 2.0; 95% confidence interval [CI] 1.5, 2.6) , pneumonia (OR 2.2; 95% CI 1.7, 2.8), and sepsis (QR 2.9; 95% CI 2.1, 4.1) . Short-term neurologic morbidity, manifest as seizures, was not related to maternal infection during labor, but was significantly related to other la bor complications. Conclusion: The main short-term neonatal consequence of chorioamnionitis is infection. Short-term neurologic morbidity in infants is related to labor complications and not chorioamnionitis per se. (C) 1999 by The American Col lege of Obstetricians and Gynecologists.