Potential conflict of interest: Nothing to report.
Effect of chorioamnionitis on brain development and injury in premature newborns†
Article first published online: 26 MAR 2009
Copyright © 2009 American Neurological Association
Annals of Neurology
Volume 66, Issue 2, pages 155–164, August 2009
How to Cite
Chau, V., Poskitt, K. J., McFadden, D. E., Bowen-Roberts, T., Synnes, A., Brant, R., Sargent, M. A., Soulikias, W. and Miller, S. P. (2009), Effect of chorioamnionitis on brain development and injury in premature newborns. Ann Neurol., 66: 155–164. doi: 10.1002/ana.21713
- Issue published online: 9 SEP 2009
- Article first published online: 26 MAR 2009
- Accepted manuscript online: 26 MAR 2009 12:00AM EST
- Manuscript Accepted: 20 MAR 2009
- Manuscript Revised: 19 MAR 2009
- Manuscript Received: 19 NOV 2008
- Canadian Institutes for Health Research. Grant Number: CHI 151135
- Bourse McLaughlin de l'Université Laval and the Fondation pour la recherche sur les maladies infantiles
- Canadian Institutes for Health Research Clinician Scientist and Michael Smith Foundation for Health Research Scholar
The association of chorioamnionitis and noncystic white matter injury, a common brain injury in premature newborns, remains controversial. Our objectives were to determine the association of chorioamnionitis and postnatal risk factors with white matter injury, and the effects of chorioamnionitis on early brain development, using advanced magnetic resonance imaging.
Ninety-two preterm newborns (24–32 weeks gestation) were studied at a median age of 31.9 weeks and again at 40.3 weeks gestation. Histopathological chorioamnionitis and white matter injury were scored using validated systems. Measures of brain metabolism (N-acetylaspartate/choline and lactate/choline) on magnetic resonance spectroscopy, and microstructure (average diffusivity and fractional anisotropy) on diffusion tensor imaging were calculated from predefined brain regions.
Thirty-one (34%) newborns were exposed to histopathological chorioamnionitis, and 26 (28%) had white matter injury. Histopathological chorioamnionitis was not associated with an increased risk of white matter injury (relative risk: 1.2; p = 0.6). Newborns with postnatal infections and hypotension requiring therapy were at higher risk of white matter injury (p < 0.03). Adjusting for gestational age at scan and regions of interest, histopathological chorioamnionitis did not significantly affect brain metabolic and microstructural development (p > 0.1). In contrast, white matter injury was associated with lower N-acetylaspartate/choline (−8.9%; p = 0.009) and lower white matter fractional anisotropy (−11.9%; p = 0.01).
Histopathological chorioamnionitis does not appear to be associated with an increased risk of white matter injury on magnetic resonance imaging or with abnormalities of brain development. In contrast, postnatal infections and hypotension are associated with an increased risk of white matter injury in the premature newborn. Ann Neurol 2009;66:155–164