Contribution of Fetal Inflammatory Response Syndrome (FIRS) with or without Maternal-Fetal Inflammation in The Placenta to Increased Risk of Respiratory and Other Complications in Preterm Neonates

Makoto Nomiyama; Takuya Nakagawa; Fumio Yamasaki; Nami Hisamoto; Natsumi Yamashita; Ayane Harai; Kanako Gondo; Masazumi Ikeda; Satoko Tsuda; Masato Ishimatsu; Yuko Oshima; Takeshi Ono; Yutaka Kozuma; Keisuke Tsumura

doi:10.3390/biomedicines11020611

Contribution of Fetal Inflammatory Response Syndrome (FIRS) with or without Maternal-Fetal Inflammation in The Placenta to Increased Risk of Respiratory and Other Complications in Preterm Neonates

Biomedicines. 2023 Feb 18;11(2):611. doi: 10.3390/biomedicines11020611.

Authors

Affiliations

¹ Department of Obstetrics and Gynecology, National Hospital Organization, Saga National Hospital, Saga 8498577, Japan.
² Department of Obstetrics and Gynecology, Faculty of Medicine, Saga University, Saga 8498501, Japan.
³ Department of Pathology, Japan Community Health Care Organization, Saga Central Hospital, Saga 8498522, Japan.

Abstract

This study classifies fetal inflammatory response syndrome (FIRS) based on the presence or absence of maternal-fetal inflammation in the placenta and clarifies the association of FIRS with neonatal morbidities. Women (330) who delivered at gestational ages of 22w0d-33w6d were enrolled and grouped into four based on FIRS and maternal/fetal inflammatory response (MIR/FIR) statuses: Group A: without FIRS and MIR/FIR (reference group); Group B: MIR/FIR alone; Group C: FIRS and MIR/FIR; and Group D: FIRS without MIR/FIR. The associations between bronchopulmonary dysplasia (BPD), adverse neonatal outcomes, extremely low gestational age and Groups B, C, and D were investigated after adjustment for potential confounders. Among patients with FIRS, 29% were in Group D. The risk of BPD was increased in Groups C (adjusted odds ratio (aOR): 3.36; 95% confidence interval (CI): 1.14-9.89) and D (aOR: 4.17; 95% CI: 1.03-16.9), as was the risk of adverse neonatal outcomes (Group C: aOR: 7.17; 95% CI: 2.56-20.1; Group D: aOR: 6.84; 95% CI: 1.85-25.2). The risk of extremely low gestational age was increased in Group D (aOR: 3.85; 95% CI: 1.56-9.52). Therefore, FIRS without MIR/FIR is not rare and may be associated with neonatal morbidities more than FIRS and MIR/FIR.

Keywords: bronchopulmonary dysplasia; chorioamnionitis; fetal inflammatory response syndrome; placenta; pregnancy; respiratory distress syndrome.

Grants and funding

This research received no external funding.