Información de la revista
Vol. 56. Núm. 6.
Páginas 551-555 (junio 2002)
Compartir
Compartir
Descargar PDF
Más opciones de artículo
Vol. 56. Núm. 6.
Páginas 551-555 (junio 2002)
Acceso a texto completo
Patología neonatal en los menores de 1.500 gramos con relación al antecedente de corioamnionitis
Neonatal morbidity and mortality in very low birth weight infants according to exposure to chorioamnionitis
Visitas
12121
G. González-Luis
Autor para correspondencia
32519ggl@comb.es

Correspondencia: Servicio de Pediatría. Hospital Sant Joan de Déu. P° Sant Joan de Déu, 2. 08950 Esplugues de Llobregat. Barcelona
, I. Jordán García, J. Rodríguez-Miguélez, F. Botet Mussons, J. Figueras Aloy
Instituto Clínico de Ginecología, Obstetricia y Neonatología. Hospital Clínic. Unidad Integrada de Pediatría. Hospital Sant Joan de Déu i Hospital Clínic. Institut d'Investigacions Biomèdiques August Pi Sunyer (IDIBAPS). Universitat de Barcelona. Barcelona
Este artículo ha recibido
Información del artículo
Resumen
Bibliografía
Descargar PDF
Estadísticas
Objetivos

Estudiar las diferencias en la incidencia de patología neonatal y mortalidad, en los recién nacidos de menos de 1.500 g, con relación a la presencia de corioamnionitis

Pacientes y métodos

Estudio caso-control de 135 recién nacidos de menos de 1.500 g de peso, nacidos entre 1988-1998. El grupo de "casos" está constituido por 45 recién nacidos con antecedentes de corioamnionitis materna según criterios clínicos o subclínicos. A cada neonato se le asignaron dos controles, el nacido inmediato anterior y posterior de menos de 1.500 g. Se analizaron los siguientes datos: aspectos perinatales, complicaciones neonatales y mortalidad

Resultados

La edad gestacional media fue de 28,5 semanas (límites, 24-38 semanas) con un peso medio de 1.131 g (límites, 520-1.500). Entre los casos hubo un período de rotura de membranas significativamente mayor (176 h frente a 57 h; p < 0,001). Presentaron infección en las primeras 72 h de vida el 40 % de los casos frente al 10 % de los controles (p < 0,0001). No se encontraron diferencias significativas en la patología ni en la mortalidad entre ambos grupos, aunque la enfermedad pulmonar crónica (20% frente a 13%) y la hemorragia intraventricular (24% frente a 17%) fueron más frecuentes en los expuestos a corioamnionitis. Necesitaron ventilación asistida un mayor número de niños de los casos (73% frente a 50%; p = 0,016) al igual que reanimación (77,8% frente a 45,6%; p = 0,001)

Conclusiones

La presencia de corioamnionitis se asocia con un riesgo mayor de infección precoz y de precisar reanimación neonatal y ventiloterapia. No existen diferencias significativas respecto a la mortalidad u otras patologías de las analizadas en este estudio

Palabras clave:
Corioamnionitis
Rotura prematura de membranas
Recién nacido prematuro
Recién nacido de muy bajo peso al nacimiento
Parto prematuro
Complicaciones gestacionales
Objectives

To study differences in the incidence of neonatal morbidity and mortality among newborns weighing less than 1,500 g according to exposure to chorioamnionitis (CA)

Patients and methods

A case-control study of 135 newborns weighing less than 1,500 g at birth and born between 1988 and 1998 was performed. The case group was composed of 45 newborns exposed to clinical or subclinical levels of maternal CA. Each newborn in the case group was matched with two controls, both weighing less than 1,500 g, one of them born immediately before and the other one immediately after. Perinatal records, neonatal morbidity and mortality were analyzed

Results

The mean gestational age was 28.5 weeks (range: 24-38 weeks) with a mean weight of 1,131 g (range: 520-1,500 g) The time of membrane rupture was significantly greater in the case group (176 h vs 57 h; p < 0.001). Forty percent of the cases presented sepsis in the first 72 h of life compared with 10 % of the controls (p < 0.0001). No significant differences in morbidity or mortality were found between the groups, although chronic lung disease (20% vs 13%) and intraventricular hemorrhage (24% vs 17%) were more frequent in infants exposed to CA. Resuscitation (77.8% vs 45.6%; p = 0.001) and mechanical ventilation (73 % vs 50 %; p = 0.016) were required by a great number of cases than controls

Conclusions

The presence of CA was associated with a higher risk of early onset infection and the need for neonatal resuscitation and mechanical ventilation. No significant differences were found in morbidity or mortality

Keywords:
Chorioamnionitis
Premature rupture of the fetal membranes
Premature newborns
Very low birth weight newborn
Premature labor
Pregnancy complications
El Texto completo está disponible en PDF
Bibliografìa
[1.]
W.J. Morales.
The effect of chorioamnionitis on the developmental outcome of preterm infants at one year.
Obstet Gynecol, 70 (1987), pp. 183-186
[2.]
W.J. Morales, S.R. Washington III, A.J. Lazar.
The effect of chorioamnionitis on perinatal outcome in preterm gestation.
J Perinatol, 7 (1987), pp. 105-110
[3.]
T.J. Garite, R.K. Freeman.
Chorioamnionitis in the preterm gestation.
Obstet Gynecol, 59 (1982), pp. 539-545
[4.]
S.L. Hillier, M.A. Krohn, N.B. Kiviat, D.H. Watts, D.A. Eschenbach.
Microbiologic causes and neonatal outcomes associated with chorioamnion infection.
Am J Obstet Gynecol, (1991), pp. 955-961
[5.]
J.M. Alexander, L.C. Gilstrap, S.M. Cox, D.M. McIntire, K.J. Leveno.
Clinical chorioamnionitis and the prognosis for very low birth weight infants.
Obstet Gynecol, 91 (1998), pp. 725-729
[6.]
S.C. Dexter, M.P. Malee, H. Pinar, J.W. Hogan, M.W. Carpenter, B.R. Vohr.
BR. Influence of chorioamnionitis on developmental outcome in very low birth weight infants.
Obstet Gynecol, 94 (1999), pp. 267-273
[7.]
R.W. Bendon, O. Faye-Petersen, Z. Pavlova, F. Qreshi, B. Mercer, M. Miodovnik.
Fetal membrane histology in preterm premature rupture of membranes: Comparison to controls and between antibiotic and placebo treatment.
Pediatr Dev Pathol, 2 (1999), pp. 552-558
[8.]
L.A. Beebe, L.D. Cowan, G. Altshuler.
The epidemiology of placental feature: Associations with gestational age and neonatal.
Obstet Gynecol, 87 (1996), pp. 771-778
[9.]
P. Borralho, F. Cunha, M. Pinto, A.T. Da Silva, M. Meirinho.
Perinatal morbidity and mortality related to gestational infection. The histological identification of chorioamnionitis and its incidence in the population studied.
Acta Med Port, 9 (1996), pp. 319-323
[10.]
K.H. Van Hoeven, A. Anyaegbunam, H. Hochster, J.E. Whitty, J. Distant, C. Crawford.
Clinical significance of increasing histologic severity of acute inflammation in the fetal membranes and umbilical cord.
Pediatr Pathol Lab Med, 16 (1996), pp. 731-744
[11.]
O. Dammann, E.N. Allred, N. Veelken.
Increased risk of spastic diplegia among very low birth weight children after preterm labor or prelabor rupture of membranes.
J Pediatr, 132 (1998), pp. 531-535
[12.]
A. Burguet, E. Monnet, J.Y. Pauchard, P.h. Roth, C. Fromentin, M.L. Dalphin.
Some risk factor for cerebral palsy in very premature infants: Importance of premature rupture of membranes and monochorionic twin placentation.
Biol Neonat, 75 (1999), pp. 177-186
[13.]
D.F. Kimberlin, J.C. Hauth, J. Owen, S.F. Bottoms, J.D. Iams, B.M. Mercer.
Indicated versus spontaneous preterm delivery. An evaluation of neonatal morbidity among infants weighing s 1,000 grams at birth.
Am J Obstet Gynecol, 180 (1999), pp. 683-689
[14.]
N.S. Hardt, M. Kostenbauder, M. Ogburn, M. Behnke, M. Resnick, A. Cruz.
Influence of chorioamnionitis on logn-term prognosis in low birth weight infants.
Obstet Gynecol, 65 (1985), pp. 5-10
[15.]
A. Leviton, N. Paneth, M.L. Reuss, M. Susser, E.N. Allred, O. Damman.
Maternal infection, fetal inflammatory response and brain damage in very low birth weight infants.
Pediatr Res, 46 (1999), pp. 566-575
[16.]
R. Romero, R. Gomez, F. Ghezzi, B.H. Yoon, M. Mazor, S.S. Edwin.
A fetal systemic inflammatory response is followed by the spontaneous onset of preterm parturition.
Am J Obstet Gynecol, 179 (1998), pp. 186-193
[17.]
F. Botet, V. Cararach, J. Sentis.
Premature rupture of membranes in early pregnancy. Neonatal prognosis.
J Perinat Med, 22 (1994), pp. 45-52
[18.]
M. Kurkinen-Raty, M. Koivisto, P. Jouppila.
Perinatal and neonatal outcome and late pulmonary sequealae in infants born after preterm premature rupture of membranes.
Obstet Gynecol, 92 (1998), pp. 408-415
[19.]
J.K. Grether, K.B. Nelson.
Maternal infection and cerebral palsy in infants of normal birth weight.
Jama, 278 (1997), pp. 207-211
[20.]
R.L. Goldenberg, J.C. Hauth, W.W. Andrews.
Intrauterine infection and preterm delivery.
N Engl J Med, 342 (2000), pp. 1500-1507
[21.]
R.C. Pattison, J.D. Makin, M. Funk, S.D. Delport, A.P. Macdonald, K. Norman.
The use of dexametasone in wome with pre-term premature rupture of membranes- a multicentre, double-blind, placebo controlled, randomized trial. Dexiprom study group.
S Afr Med J, 89 (1999), pp. 865-870
[22.]
V. Cararach, F. Botet, J. Sentis, R. Almirall, E. Perez-Picañol.
Administration of antibiotics to patients with rupture of membranes at term: A prospective, randomized, multicentric study.
Acta Obstet Gynecol Scand, 77 (1998), pp. 298-302
[23.]
R.F. Lamont.
The prevention of preterm birth with the use of antibiotics.
Eur J Pediatr, 158 (1999), pp. 2-4
[24.]
J.M. Ernest.
Neonatal consequences of preterm PROM.
Clin Obstet Gynecol, 41 (1998), pp. 827-831
[25.]
C. Egarter, H. Leitich, P. Husslein, A. Kaider, M. Schemprer.
Adjunctive antibiotic treatment in preterm labor and neonatal.
Obstet Gynecol, 88 (1996), pp. 303-309
[26.]
A. Farooqi, P.A. Holmgren, S. Engberg, F. Serenius.
Survival and 2-year outcome with expectant management of second trimester rupture of membranes.
Obstet Gynecol, 92 (1998), pp. 895-901
[27.]
K.L. Watterberg, L.M. Demers, S.M. Scott, S. Murphy.
Chorioamnionitis and early lung inflammation in infants in whom broncho-pulmonary dysplasia develops.
Pediatrics, 97 (1996), pp. 210-215
[28.]
R. Sapolsky, C. Rivier, G. Yamamoto, P. Plotsky, W. Vale.
Interleukin-1 stimulates the secretion of hypothalamic corticotropin-releasing factor.
Science, 238 (1987), pp. 522-524
[29.]
E.W. Bernton, J.E. Beach, J.W. Holaday, R.C. Smallridge, H.G. Fein.
Release of multiple hormones by a direct action of interleukin-1 on pituitary cells.
Science, 238 (1987), pp. 519-521
[30.]
M. Fujimura, T. Takeuchi, H. Kitajima, M. Nakayama.
Chorioamnionitis and serum IgM in Wilson-Mikity syndrome.
Arch Dis Child, 64 (1989), pp. 1379-1383
[31.]
M. Fujimura, H. Kitajima, M. Nakayama.
Increased leukocyte elastase of the tracheal aspirate at birth and neonatal pulmonary emphysema.
Pediatrics, 92 (1993), pp. 564-569
[32.]
B. Gonik, S.F. Bottoms, D.B. Cotton.
Amniotic fluid volume as a risk factor in preterm premature rupture of the membranes.
Obstet Gynecol, 65 (1985), pp. 456-459
[33.]
A.M. Vintxileos, W.A. Campbell, D.J. Nochimson, P.J. Weinbaum.
Degree of oligohydramnios and pregnancy outcome in patients with premature rupture of the membranes.
Obstet Gynecol, 66 (1985), pp. 162-167
[34.]
R. Romero, R. Gomez, M. Galasso, C.M. Salafia, B.H. Yoon, E. Behnke.
Is olygohydramnios a risk factor for infection in term premature rupture of membranes?.
Ultrasound Obstet Gynecol, 4 (1994), pp. 95-100
[35.]
H.A. Hadi, C.A. Hodson, D. Strickland.
Premature rupture of the membranes between 20 and 25 weeks' gestation: Role of amniotic fluik volume in perinatal outcome.
Am J Obstet Gynecol, 170 (1994), pp. 1139-1144
[36.]
A. Rotschild, E.W. Ling, H.I. PuttermanI.
Neonatal outcome after prolonged preterm premature rupture of the membranes.
Am J Obstet Gynecol, 162 (1990), pp. 46-52
[37.]
C. Nimrod, G. Varela, F. Hinzs.
The effect of very prolonged membrane rupture on fetal development.
Am J Obstet Gynecol, 148 (1984), pp. 540-543
[38.]
B.H. Yoon, Y.A. Kim, R. Romero, J.C. Kim, K.H. Park, M.H. Kim.
Association of oligohydramnios in women with preterm premature rupture of membranes with an inflammatory response in fetal, amniotic, and maternal compartments.
Am J Obstet Gynecol, 181 (1999), pp. 784-788
Copyright © 2002. Asociación Española de Pediatría
Descargar PDF
Idiomas
Anales de Pediatría
Opciones de artículo
Herramientas
es en

¿Es usted profesional sanitario apto para prescribir o dispensar medicamentos?

Are you a health professional able to prescribe or dispense drugs?