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Pediatr Res. 2017 Oct;82(4):691-696. doi: 10.1038/pr.2017.128. Epub 2017 Jun 21.

Both antenatal and postnatal inflammation contribute information about the risk of brain damage in extremely preterm newborns.

Author information

1
Division of Newborn Medicine, Department of Pediatrics, Floating Hospital for Children at Tufts Medical Center, Boston, Massachusetts.
2
Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, Michigan.
3
Department of Neurology, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts.
4
Departments of Obstetrics, Gynecology and Reproductive Biology, Brigham and Women's Hospital and Harvard Medical School, Boston Massachusetts.
5
Department of Pediatrics, University of North Carolina, Chapel Hill North Carolina.
6
Departments of Pediatrics and Neurology, Boston Medical Center and Boston University School of Medicine, Boston Massachusetts.
7
Department of Public Health &Community Medicine, Tufts University School of Medicine, Boston, Massachusetts.

Abstract

BackgroundPreterm newborns exposed to intrauterine inflammation are at an increased risk of neurodevelopmental disorders. We hypothesized that adverse outcomes are more strongly associated with a combination of antenatal and postnatal inflammation than with either of them alone.MethodsWe defined antenatal inflammation as histologic inflammation in the placenta. We measured the concentrations of seven inflammation-related proteins in blood obtained on postnatal days 1, 7, and 14 from 763 infants born before 28 weeks of gestation. We defined postnatal inflammation as a protein concentration in the highest quartile on at least 2 days. We used logistic regression models to evaluate the contribution of antenatal and postnatal inflammation to the risk of neurodevelopmental disorders.ResultsThe risk of white matter damage was increased when placental inflammation was followed by sustained elevation of C-reactive protein or ICAM-1. We found the same for spastic cerebral palsy when placental inflammation was followed by elevation of TNF-α or IL-8. The presence of both placental inflammation and elevated levels of IL-6, TNF-α, or ICAM-1 was associated with an increased risk for microcephaly.ConclusionCompared with a single hit, two inflammatory hits are associated with stronger risk for abnormal cranial ultrasound, spastic cerebral palsy, and microcephaly at 2 years.

PMID:
28549057
PMCID:
PMC5599336
DOI:
10.1038/pr.2017.128
[Indexed for MEDLINE]
Free PMC Article

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