Association of Chorioamnionitis with Cerebral Palsy at Two Years after Spontaneous Very Preterm Birth: The EPIPAGE-2 Cohort Study

Emeline Maisonneuve; Elsa Lorthe; Héloïse Torchin; Pierre Delorme; Louise Devisme; Laurence Foix L'Hélias; Stéphane Marret; Damien Subtil; Florence Bodeau-Livinec; Véronique Pierrat; Loïc Sentilhes; François Goffinet; Pierre-Yves Ancel; Gilles Kayem; EPIPAGE-2 Obstetric writing group

doi:10.1016/j.jpeds.2020.03.021

Association of Chorioamnionitis with Cerebral Palsy at Two Years after Spontaneous Very Preterm Birth: The EPIPAGE-2 Cohort Study

J Pediatr. 2020 Jul:222:71-78.e6. doi: 10.1016/j.jpeds.2020.03.021.

Authors

Collaborators

Affiliations

¹ Obstetrical, Perinatal and Pediatric Epidemiology Research Team, Center for Epidemiology and Statistics Sorbonne Paris Cité, INSERM U1153, Paris, France; Department of Fetal Medicine, Hôpital Armand Trousseau, Assistance Publique-Hôpitaux de Paris, Sorbonne University, Paris, France. Electronic address: emelinem@yahoo.com.
² Obstetrical, Perinatal and Pediatric Epidemiology Research Team, Center for Epidemiology and Statistics Sorbonne Paris Cité, INSERM U1153, Paris, France; EPIUnit-Institute of Public Health, University of Porto, Porto, Portugal.
³ Obstetrical, Perinatal and Pediatric Epidemiology Research Team, Center for Epidemiology and Statistics Sorbonne Paris Cité, INSERM U1153, Paris, France; Paris Descartes University, France; Neonatal Intensive Care Unit, Hôpital Cochin, Paris, France.
⁴ Obstetrical, Perinatal and Pediatric Epidemiology Research Team, Center for Epidemiology and Statistics Sorbonne Paris Cité, INSERM U1153, Paris, France; Paris Descartes University, France; Department of Obstetrics and Gynecology, Maternité Port-Royal, Groupe Hospitalier Cochin Broca Hôtel-Dieu, Assistance Publique-Hôpitaux de Paris, DHU Risques et Grossesse, Paris, France.
⁵ Department of Pathology, Lille University Hospital CHRU, Lille, France.
⁶ Obstetrical, Perinatal and Pediatric Epidemiology Research Team, Center for Epidemiology and Statistics Sorbonne Paris Cité, INSERM U1153, Paris, France; Paris Descartes University, France; Neonatal Care Unit, Hôpital Armand Trousseau, Assistance Publique-Hôpitaux de Paris, Sorbonne University, Paris, France.
⁷ Neonatal Pediatrics and Intensive Care Unit, Neuropediatrics Department, Centre de référence des troubles des apprentissages de l'enfant, CAMPS, Hôpital Charles Nicolle, Rouen, France; INSERM U1245 - Neovasc team - Perinatal handicap, Institute of Biomedical Research and Innovation, Normandy University, Rouen, France.
⁸ CHU Lille, Department of Obstetrics and Gynaecology, Jeanne de Flandre Hospital, Lille, France; A 4489, Lille North of France University, Lille, France.
⁹ Obstetrical, Perinatal and Pediatric Epidemiology Research Team, Center for Epidemiology and Statistics Sorbonne Paris Cité, INSERM U1153, Paris, France; Ecole des Hautes Etudes en Santé Publique, Rennes, France.
¹⁰ Obstetrical, Perinatal and Pediatric Epidemiology Research Team, Center for Epidemiology and Statistics Sorbonne Paris Cité, INSERM U1153, Paris, France; CHU Lille, Department of Neonatal Medicine, Jeanne de Flandre Hospital, Lille, France.
¹¹ Department of Obstetrics and Gynecology, Bordeaux University Hospital, Bordeaux, France.
¹² Obstetrical, Perinatal and Pediatric Epidemiology Research Team, Center for Epidemiology and Statistics Sorbonne Paris Cité, INSERM U1153, Paris, France; Paris Descartes University, France; Clinical Research Unit, Center for Clinical Investigation P1419, Cochin Broca Hôtel-Dieu Hospital, Paris, France.
¹³ Obstetrical, Perinatal and Pediatric Epidemiology Research Team, Center for Epidemiology and Statistics Sorbonne Paris Cité, INSERM U1153, Paris, France; Paris Descartes University, France; Department of Obstetrics and Gynecology, Hôpital Armand Trousseau, Sorbonne University, Assistance Publique-Hôpitaux de Paris, Paris, France.

PMID: 32586536
DOI: 10.1016/j.jpeds.2020.03.021

Abstract

Objective: To assess whether chorioamnionitis is associated with cerebral palsy (CP) or death at 2 years' corrected age in infants born before 32 weeks of gestation after spontaneous birth.

Study design: EPIPAGE-2 is a national, prospective, population-based cohort study of children born preterm in France in 2011; recruitment periods varied by gestational age. This analysis includes infants born alive after preterm labor or preterm premature rupture of membranes from 24^0/7 to 31^6/7 weeks of gestation. We compared the outcomes of CP, death at 2 years' corrected age, and "CP or death at age 2" according to the presence of either clinical chorioamnionitis or histologic chorioamnionitis. All percentages were weighted by the duration of the recruitment period.

Results: Among 2252 infants born alive spontaneously before 32 weeks of gestation, 116 (5.2%) were exposed to clinical chorioamnionitis. Among 1470 with placental examination data available, 639 (43.5%) had histologic chorioamnionitis. In total, 346 infants died before 2 years and 1586 (83.2% of the survivors) were evaluated for CP at age 2 years. CP rates were 11.1% with and 5.0% without clinical chorioamnionitis (P = .03) and 6.1% with and 5.3% without histologic chorioamnionitis (P = .49). After adjustment for confounding factors, CP risk rose with clinical chorioamnionitis (aOR 2.13, 95% CI 1.12-4.05) but not histologic chorioamnionitis (aOR 1.21, 95% 0.75-1.93). Neither form was associated with the composite outcome "CP or death at age 2."

Conclusions: Among infants very preterm born spontaneously, the risk of CP at a corrected age of 2 years was associated with exposure to clinical chorioamnionitis but not histologic chorioamnionitis.

Keywords: cerebral palsy; chorioamnionitis; cohort study; intrauterine infection; preterm birth.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Cause of Death
Cerebral Palsy / etiology*
Child, Preschool
Chorioamnionitis* / diagnosis
Cohort Studies
Female
Fetal Membranes, Premature Rupture
Humans
Infant, Premature
Male
Pregnancy
Premature Birth
Prospective Studies
Time Factors