Study On The Effect Of Histological Chorioamnionitis On The Outcome Of Premature Infants ＜34 Weeks

ObjectiveObjective to explore the effect of histologic chorioamnionitis(HCA)on the outcome of preterm infants with gestational age < 34 weeks by retrospective analysis of clinical data of mother and infant,so as to provide reference for the prevention and treatment of complications of preterm infants with gestational age < 34 weeks.MethodsThe clinical data of 689 premature infants and mothers who met the criteria were collected by retrospective cohort study method during the period from June 1,2018 to May 31,2020.According to the pathological results of placenta,HCA(+)group and HCA(-)group were divided into two groups,and the clinical data of mother and infant and the outcome of premature infants were compared;And then,the subgroups were analyzed: according to the results of placenta classification of HCA,the cases were divided into hca1 group,level 2 and level 3 group and negative group,and compared the outcome of premature infants among subgroups.After adjusting the confounding factors with logistic regression,the effects of HCA(+)on the main complications and clinical outcomes of premature infants < 34 weeks were analyzed.HCA was predicted by drawing receiver operating characteristic curve(ROC).Results1.According to the inclusion and exclusion criteria,689 preterm infants were selected,including 200 in HCA(+)group and 489 in HCA(-)group.With the increase of gestational age,the positive rate of HCA decreased.The incidence of premature rupture of membranes was 41.5%.With the extension of the time of premature rupture of membranes,the incidence of HCA increased.2.The gestational age,birth weight and cesarean section rate of premature infants in HCA(+)group were lower than those in HCA(-)group(P < 0.05);There was no significant difference in 1min,5min Apgar score < 7,amniotic fluid pollution,resuscitation history at birth and neonatal asphyxia between the two groups(P > 0.05).3.Univariate analysis showed that the incidence of neonatal respiratory distress syndrome(RDS)decreased,early-onset sepsis(EOS),bronchopulmonary dysplasia(BPD)and retinopathy of prematurity(ROP)increased in HCA(+)group,and there was significant difference between the two groups(P < 0.05).After adjusting for confounding factors by logistic regression,the incidence of RDS in HCA(+)group was still lower than that in negative group,and the incidence of EOS in HCA(+)group was higher than that in negative group(P< 0.05),but there was no significant difference in BPD and ROP between the two groups(P >0.05,or = 1.074,1.035,95% CI = 0.530-2.176,0.608-1.761,respectively);There was no significant difference in late-onset sepsis(LOS),neonatal necrotizing enterocolitis(NEC),intraventricular hemorrhage(IVH),periventricular leukomalacia(PVL),focal white matter injury and death between the two groups.The inflammatory infiltration of HCA was negatively correlated with the severity of RDS;Different grades of HCA had no significant effect on the occurrence of major complications in preterm infants less than 34 weeks old.4.Draw the ROC curve and look for laboratory indicators to predict HCA.The area under the ROC curve of the combined detection of white blood cell(WBC),C-reactive protein(CRP)and neutrophil ratio within 48 hours before pregnancy is 0.754,the sensitivity is 86.7%,and the specificity is 58.3%,which was higher than the area and sensitivity under the curve of WBC,CRP and neutrophil ratio alone,but the specificity was low.And the value of diagnosis is not high.Conclusions1.HCA reduced the incidence rate of RDS in premature infants less than 34 weeks,and increased the incidence rate of EOS.We should pay attention to the prevention and treatment of HCA in order to reduce the incidence of EOS in premature infants with gestational age <34 weeks.2.HCA increased the incidence rate of BPD and ROP in premature infants less than 34 weeks.HCA may increase the incidence of BPD and ROP by increasing the birth of small gestational age infants,emphasizing the importance of preventing the occurrence of early and middle preterm birth.3.HCA had no significant effect on the incidence rate of LOS,NEC,IVH,PVL,focal white matter injury and death in premature infants with gestational age less than 34 weeks.Different grades of HCA had no significant effect on the incidence rate of major complications in premature infants with gestational age less than 34 weeks.