Maternal infection, fetal inflammatory response, and brain damage in very low birth weight infants

Echolucent images (EL) of cerebral white matter, seen on cranial ultrasonog raphic scans of very low birth weight newborns, predict motor and cognitive limitations. We tested the hypothesis that markers of maternal and fete-pl acental 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 x g. Maternal infection was indicated by fever, leuk ocytosis, and receipt of antibiotic; fetoplacental inflammation was indicat ed by the presence of fetal vasculitis (i.e. of the placental chorionic pla te or the umbilical cord). The effect of membrane inflammation was also ass essed. All analyses were performed separately in infants born within 1 h of membrane rupture (n = 537), or after a longer interval (n = 541), to deter mine whether infection markers have different effects in infants who are un likely to have experienced ascending amniotic sac infection as a consequenc e of membrane rupture. Placental membrane inflammation by itself was not as sociated with risk of EL at any time. The risks of both early and late EL w ere substantially increased in infants with fetal vasculitis, but the assoc iation with early EL was found only in infants born greater than or equal t o 1 after membrane rupture and who had membrane inflammation (adjusted OR n ot calculable), whereas the association of fetal vasculitis with late EL wa s seen only in infants born <1 h after membrane rupture (OR = 10.8; p = 0.0 5). Maternal receipt of antibiotic in the 24 h just before delivery was ass ociated 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 infla mmatory response are strongly and independently associated with EL, particu larly late EL.