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Revista chilena de pediatría

versión impresa ISSN 0370-4106

Resumen

MORAES C, MARIO et al. Histological chorioamnionitis in the newborn with birth weight less than 1 000 g perinatal incidence and results. Rev. chil. pediatr. [online]. 2008, vol.79, n.1, pp.98-104. ISSN 0370-4106.  http://dx.doi.org/10.4067/S0370-41062008000100014.

Objective: Determine the incidence of clinical and histological chorioamnionitis on extremely low birth weight infants and its correlation with perinatal outcome. Method: Descriptive and prospective study carried out between May 2004 and April 2005. All newborns weighting between 500 - 1 000 g and with placental histopathological study were included. Results: A total of 52 infants fulfilled the inclusion criteria. Histological study of the placenta was performed in 44 patients (84.6%). The average birth weight was 822.3 g (SD 127 g) and the mean gestational age was 26 weeks (SD 2 weeks). Preterm labour was recorded in 28 mothers (63.6%), where 18 (40.9%o) had premature membrane rupture. Histological diagnosis of chorioamnionitis was done in 27 cases (61.4%), where 12 (27.2%) had a clinical diagnosis of chorioamnionitis previously. In 13 of 27 cases with histological chorioamnionitis, no premature membrane rupture was recorded. 75%> (9) of patients with clinical diagnosis presented chorioamnionitis with fetal response in the placenta at the histological study. In 5 cases, histological chorioamnionitis with fetal response was found in absence of clinical diagnosis. Early neonatal mortality was observed in 15 (34%) cases and mortality during hospitalization in 23 (52.2%). Neonatal sepsis developed in 2 patients (4.5%), but 11 cases (25%) presented early clinical sepsis, all of them associated to histological chorioamnionitis (*p = 0.02). In 5 cases, necrotizing enterocolitis was observed (11.3%) and intraventricular hemorrhage in 12 (27.2%), in which 7 were grade 3 to 4 (16.2%). Finally, 9 had bronchopulmonary dysplasia, associated to histological chorioamnionitis with fetal response (*p = 0.01). Conclusions: Histological chorioamnionitis has a high incidence; 44% of cases, it was possible to confirm that it preceded membrane rupture. Chorioamnionitis is often clinically silent and is diagnosed by the pathologist after birth. Clinical diagnosis of chorioamnionitis presents low sensitivity and high specificity in relation to histological chorioamnionitis. Clinical suspicion of ovular infection is highly suggestive of advanced infection with histological fetal response. Histological choriamnionitis is statistically associated to preterm labour and early clinical sepsis. Histological chorioamnionitis with fetal response is statistically associated with bronchopulmonary dysplasia and necrotizing enterocolitis

Palabras clave : Chorioamnionitis; newborn; very low birth weight.

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