Subscribe to RSS
Please copy the URL and add it into your RSS Feed Reader.
https://www.thieme-connect.de/rss/thieme/en/10.1055-s-00029028.xml
Download PDF
J Pediatr Infect Dis 2017; 12(03): 157-163
DOI: 10.1055/s-0037-1603101
DOI: 10.1055/s-0037-1603101
Review Article
Chorioamnionitis-Induced Immunological Changes and Neonatal Outcome
Further Information
Publication History
08 December 2016
26 December 2016
Publication Date:
17 May 2017 (online)
Abstract
Chorioamnionitis is inflammation of the fetal membranes (chorion and amnion) which could be of microbial or nonmicrobial etiology. It is a common complication of pregnancy with significant implications for both mother and infant. It represents a spectrum of diseases, which range from histological but subclinical chorioamnionitis to funisitis and chorionic vasculitis with multiorgan involvement in the fetus. Chorioamnionitis results in the activation of the fetal innate immune system known as the fetal inflammatory response syndrome (FIRS). FIRS with or without evidence of microbial presence initiates an inflammatory cascade that has been implicated in the mechanisms responsible for the fetal injury. Such injury can result in adverse neonatal outcomes involving multiple organ systems with high perinatal and long-term morbidity and mortality. While antimicrobial treatment of chorioamnionitis is beneficial to the mother, it is unclear whether the same holds true for the fetus as the damage may already be done by the production of proinflammatory cytokines. This article reviews the immunological changes and their consequences in neonates born to mothers with chorioamnionitis.
-
References
- 1 Henson PM. Dampening inflammation. Nat Immunol 2005; 6 (12) 1179-1181
- 2 Gotsch F, Romero R, Kusanovic JP. , et al. The fetal inflammatory response syndrome. Clin Obstet Gynecol 2007; 50 (03) 652-683
- 3 Blanc WA. Pathways of fetal and early neonatal infection. Viral placentitis, bacterial and fungal chorioamnionitis. J Pediatr 1961; 59: 473-496
- 4 Higgins RD, Saade G, Polin RA. , et al; Chorioamnionitis Workshop Participants. Evaluation and management of women and newborns with a maternal diagnosis of chorioamnionitis: summary of a workshop. Obstet Gynecol 2016; 127 (03) 426-436
- 5
Yoon BH,
Romero R,
Kim CJ.
, et al. Amniotic fluid interleukin-6: a sensitive test for antenatal diagnosis of
acute inflammatory lesions of preterm placenta and prediction of perinatal morbidity.
Am J Obstet Gynecol 1995; 172 (03) 960-970
MissingFormLabel
- 6 Pacora P, Chaiworapongsa T, Maymon E. , et al. Funisitis and chorionic vasculitis: the histological counterpart of the fetal inflammatory response syndrome. J Matern Fetal Neonatal Med 2002; 11 (01) 18-25
- 7 Tita AT, Andrews WW. Diagnosis and management of clinical chorioamnionitis. Clin Perinatol 2010; 37 (02) 339-354
- 8 Eschenbach DA. Ureaplasma urealyticum and premature birth. Clin Infect Dis 1993; 17 (Suppl. 01) S100-S106
- 9 Romero R, Espinoza J, Gonçalves LF, Kusanovic JP, Friel L, Hassan S. The role of inflammation and infection in preterm birth. Semin Reprod Med 2007; 25 (01) 21-39
- 10 Grobman WA, Bailit JL, Rice MM. , et al; Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) Maternal-Fetal Medicine Units (MFMU) Network. Frequency of and factors associated with severe maternal morbidity. Obstet Gynecol 2014; 123 (04) 804-810
- 11 Burke C, Chin EG. Chorioamnionitis at term: definition, diagnosis, and implications for practice. J Perinat Neonatal Nurs 2016; 30 (02) 106-114
- 12
Yoon BH,
Romero R,
Moon JB.
, et al. Clinical significance of intra-amniotic inflammation in patients with preterm
labor and intact membranes. Am J Obstet Gynecol 2001; 185 (05) 1130-1136
MissingFormLabel
- 13 Goldenberg RL, Hauth JC, Andrews WW. Intrauterine infection and preterm delivery. N Engl J Med 2000; 342 (20) 1500-1507
- 14 Lahra MM, Beeby PJ, Jeffery HE. Intrauterine inflammation, neonatal sepsis, and chronic lung disease: a 13-year hospital cohort study. Pediatrics 2009; 123 (05) 1314-1319
- 15 Rather LJ. Disturbance of function (functio laesa): the legendary fifth cardinal sign of inflammation, added by Galen to the four cardinal signs of Celsus. Bull N Y Acad Med 1971; 47 (03) 303-322
- 16 Haddad R, Tromp G, Kuivaniemi H. , et al. Human spontaneous labor without histologic chorioamnionitis is characterized by an acute inflammation gene expression signature. Am J Obstet Gynecol 2006; 195 (02) 394.e1-394.e24
- 17 Yoon BH, Romero R, Park JS. , et al. The relationship among inflammatory lesions of the umbilical cord (funisitis), umbilical cord plasma interleukin 6 concentration, amniotic fluid infection, and neonatal sepsis. Am J Obstet Gynecol 2000; 183 (05) 1124-1129
- 18 Salvemini D, Cuzzocrea S. Oxidative stress in septic shock and disseminated intravascular coagulation. Free Radic Biol Med 2002; 33 (09) 1173-1185
- 19 Hoffman M, Cooper ST. Thrombin enhances monocyte secretion of tumor necrosis factor and interleukin-1 beta by two distinct mechanisms. Blood Cells Mol Dis 1995; 21 (02) 156-167
- 20 Romero R, Miranda J, Chaemsaithong P. , et al. Sterile and microbial-associated intra-amniotic inflammation in preterm prelabor rupture of membranes. J Matern Fetal Neonatal Med 2015; 28 (12) 1394-1409
- 21 Kim CJ, Romero R, Chaemsaithong P, Chaiyasit N, Yoon BH, Kim YM. Acute chorioamnionitis and funisitis: definition, pathologic features, and clinical significance. Am J Obstet Gynecol 2015; 213 (4, Suppl): S29-S52
- 22 Hillier SL, Witkin SS, Krohn MA, Watts DH, Kiviat NB, Eschenbach DA. The relationship of amniotic fluid cytokines and preterm delivery, amniotic fluid infection, histologic chorioamnionitis, and chorioamnion infection. Obstet Gynecol 1993; 81 (06) 941-948
- 23 Redline RW, Faye-Petersen O, Heller D, Qureshi F, Savell V, Vogler C. ; Society for Pediatric Pathology, Perinatal Section, Amniotic Fluid Infection Nosology Committee. Amniotic infection syndrome: nosology and reproducibility of placental reaction patterns. Pediatr Dev Pathol 2003; 6 (05) 435-448
- 24 Matzinger P. The danger model: a renewed sense of self. Science 2002; 296 (5566): 301-305
- 25 Hashimoto C, Hudson KL, Anderson KV. The Toll gene of Drosophila, required for dorsal-ventral embryonic polarity, appears to encode a transmembrane protein. Cell 1988; 52 (02) 269-279
- 26 Medzhitov R, Janeway Jr C. The Toll receptor family and microbial recognition. Trends Microbiol 2000; 8 (10) 452-456
- 27 Beg AA. Endogenous ligands of Toll-like receptors: implications for regulating inflammatory and immune responses. Trends Immunol 2002; 23 (11) 509-512
- 28 Dranoff G. Cytokines in cancer pathogenesis and cancer therapy. Nat Rev Cancer 2004; 4 (01) 11-22
- 29 Romero R, Gotsch F, Pineles B, Kusanovic JP. Inflammation in pregnancy: its roles in reproductive physiology, obstetrical complications, and fetal injury. Nutr Rev 2007; 65 (12 Pt 2): S194-S202
- 30 Gomez R, Romero R, Ghezzi F, Yoon BH, Mazor M, Berry SM. The fetal inflammatory response syndrome. Am J Obstet Gynecol 1998; 179 (01) 194-202
- 31 Ozalkaya E, Karatekin G, Topcuoğlu S, Gürsoy T, Ovalı F. Morbidity in preterm infants with fetal inflammatory response syndrome. Pediatr Int 2016; 58 (09) 850-854
- 32 D'Alquen D, Kramer BW, Seidenspinner S. , et al. Activation of umbilical cord endothelial cells and fetal inflammatory response in preterm infants with chorioamnionitis and funisitis. Pediatr Res 2005; 57 (02) 263-269
- 33 Yoon BH, Romero R, Kim KS. , et al. A systemic fetal inflammatory response and the development of bronchopulmonary dysplasia. Am J Obstet Gynecol 1999; 181 (04) 773-779
- 34 Yoon BH, Romero R, Shim JY, Shim SS, Kim CJ, Jun JK. C-reactive protein in umbilical cord blood: a simple and widely available clinical method to assess the risk of amniotic fluid infection and funisitis. J Matern Fetal Neonatal Med 2003; 14 (02) 85-90
- 35 Sampson JE, Theve RP, Blatman RN. , et al. Fetal origin of amniotic fluid polymorphonuclear leukocytes. Am J Obstet Gynecol 1997; 176 (1 Pt 1): 77-81
- 36 Shim SS, Romero R, Hong JS. , et al. Clinical significance of intra-amniotic inflammation in patients with preterm premature rupture of membranes. Am J Obstet Gynecol 2004; 191 (04) 1339-1345
- 37 Annane D, Bellissant E, Cavaillon JM. Septic shock. Lancet 2005; 365 (9453): 63-78
- 38 Beutler B, Cerami A. The endogenous mediator of endotoxic shock. Clin Res 1987; 35 (03) 192-197
- 39 Beutler B. Sepsis begins at the interface of pathogen and host. Biochem Soc Trans 2001; 29 (Pt 6): 853-859
- 40 Beutler B, Hoebe K, Du X, Ulevitch RJ. How we detect microbes and respond to them: the Toll-like receptors and their transducers. J Leukoc Biol 2003; 74 (04) 479-485
- 41 Lolis E, Bucala R. Therapeutic approaches to innate immunity: severe sepsis and septic shock. Nat Rev Drug Discov 2003; 2 (08) 635-645
- 42 Jean-Baptiste E. Cellular mechanisms in sepsis. J Intensive Care Med 2007; 22 (02) 63-72
- 43 Romero R, Mazor M, Manogue K, Oyarzun E, Cerami A. Human decidua: a source of cachectin-tumor necrosis factor. Eur J Obstet Gynecol Reprod Biol 1991; 41 (02) 123-127
- 44 Yoneyama Y, Suzuki S, Sawa R. , et al. Changes in the proportion of T helper 1 and T helper 2 cells in cord blood after premature rupture of membranes. Arch Gynecol Obstet 2003; 267 (04) 217-220
- 45 Kim SK, Romero R, Chaiworapongsa T. , et al. Evidence of changes in the immunophenotype and metabolic characteristics (intracellular reactive oxygen radicals) of fetal, but not maternal, monocytes and granulocytes in the fetal inflammatory response syndrome. J Perinat Med 2009; 37 (05) 543-552
- 46 Selmaj KW, Raine CS. Tumor necrosis factor mediates myelin and oligodendrocyte damage in vitro. Ann Neurol 1988; 23 (04) 339-346
- 47 D'Souza SD, Alinauskas KA, Antel JP. Ciliary neurotrophic factor selectively protects human oligodendrocytes from tumor necrosis factor-mediated injury. J Neurosci Res 1996; 43 (03) 289-298
- 48 Kahn MA, De Vellis J. Regulation of an oligodendrocyte progenitor cell line by the interleukin-6 family of cytokines. Glia 1994; 12 (02) 87-98
- 49 Kahn MA, de Vellis J. Growth factors in the CNS and their effects on oligodendroglia. Prog Brain Res 1995; 105: 145-169
- 50 Yoon BH, Jun JK, Romero R. , et al. Amniotic fluid inflammatory cytokines (interleukin-6, interleukin-1beta, and tumor necrosis factor-alpha), neonatal brain white matter lesions, and cerebral palsy. Am J Obstet Gynecol 1997; 177 (01) 19-26
- 51 Martinez-Tallo E, Claure N, Bancalari E. Necrotizing enterocolitis in full-term or near-term infants: risk factors. Biol Neonate 1997; 71 (05) 292-298
- 52 Van Parijs L, Abbas AK. Homeostasis and self-tolerance in the immune system: turning lymphocytes off. Science 1998; 280 (5361): 243-248
- 53 Verani JR, McGee L, Schrag SJ. Prevention of perinatal group B streptococcal disease. Revised guidelines from CDC, 2010. MMWR. Recommendation and reports . 2010; 59 (RR-10); 1-32
- 54 Polin RA. ; Committee on Fetus and Newborn. Management of neonates with suspected or proven early-onset bacterial sepsis. Pediatrics 2012; 129 (05) 1006-1015
- 55 Intrapartum care: care of healthy women and their babies during childbirth Clinical guideline [CG55]. Available at: https://www.nice.org.uk/Guidance/cg55 . Accessed August 20, 2016
- 56 Kenyon SL, Taylor DJ, Tarnow-Mordi W. ; ORACLE Collaborative Group. Broad-spectrum antibiotics for preterm, prelabour rupture of fetal membranes: the ORACLE I randomised trial. Lancet 2001; 357 (9261): 979-988