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Chorioamnionitis with or without funisitis increases the risk of hypotension in very low birthweight infants on the first postnatal day but not later

¹ Department of Paediatrics and Adolescent Medicine, Princess Margaret Hospital, Kwai Chung, New Territories, Hong Kong SAR
² Department of Paediatrics, Kwong Wah Hospital, Waterloo Road, Hong Kong SAR
³ Department of Paediatrics and Ritchie Centre for Baby Health Research, Monash University, Monash Medical Centre, Clayton Road, Melbourne, Australia

Correspondence to:
Correspondence to:
Dr Lee
Department of Paediatrics and Adolescent Medicine, Princess Margaret Hospital, Kwai Chung, New Territories, Hong Kong SAR; leesyr{at}netvigator.com

Objective: To evaluate the relation between chorioamnionitis and hypotension in very low birthweight infants.

Methods: Retrospective cohort study in infants with a birth weight of <1500 g born between January 2002 and September 2004. The placentas were examined for evidence of chorioamnionitis and funisitis. Hypotension was defined by the use of vasopressors.

Results: Of 105 infants, 37 (35%) were chorioamnionitis positive. The onset of hypotension had a skewed distribution: day 1 for 30 episodes and scattered from day 2 to day 19 for the remaining 22. Of the 30 infants who developed hypotension on day 1, 17 (57%) were chorioamnionitis positive. The mean maturity of the chorioamnionitis positive group was 27.91 weeks, marginally less than the mean maturity of 29.05 weeks of the chorioamnionitis negative group (p = 0.05). After adjustment of the effects for confounding variables (birth weight, gestation, surfactant therapy, mechanical ventilation on day 1, high frequency oscillatory ventilation, patent ductus arteriosus), chorioamnionitis was the significant factor in line with hypotension developing on day 1 (adjusted odds ratio 5.14, 95% confidence interval 1.51 to 17.50). There was no evidence that hypotension developing after day 1 was associated with chorioamnionitis.

Conclusions: There is a strong association between chorioamnionitis and hypotension developing on day 1 in very low birthweight infants.

Abbreviations: HFOV, high frequency oscillatory ventilation; PDA, patent ductus arteriosus; VLBW, very low birthweight

Keywords: chorioamnionitis; funisitis; hypotension; very low birthweight infants; cytokines