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Effect of clinical chorioamnionitis on breathing effort in premature infants at birth: a retrospective case–control study
  1. Timothy J R Panneflek1,
  2. Kristel L A M Kuypers1,
  3. Graeme R Polglase2,3,
  4. Stuart B Hooper2,3,
  5. Thomas van den Akker4,5,
  6. Arjan B te Pas1
  1. 1 Division of Neonatology, Department of Paediatrics, Willem-Alexander Children's Hospital, Leiden University Medical Centre, Leiden, the Netherlands
  2. 2 The Ritchie Centre, Hudson Institute of Medical Research, Clayton, VIC, Australia
  3. 3 Department of Obstetrics and Gynaecology, Monash University, Clayton, VIC, Australia
  4. 4 Department of Obstetrics, Leids Universitair Medisch Centrum, Leiden, the Netherlands
  5. 5 Athena Institute, VU University, Amsterdam, the Netherlands
  1. Correspondence to Mr Timothy J R Panneflek, Neonatology, Leiden University Medical Center, Leiden, Netherlands; t.j.r.panneflek{at}


Rationale Antenatal inflammation, usually associated with chorioamnionitis, is a major cause of premature birth. As inflammation could depress respiratory drive, we have examined the effect of clinical chorioamnionitis (CCA) on spontaneous breathing in premature infants at birth.

Methods Infants with CCA born <30 weeks’ gestation were matched with control infants based on gestational age (±6 days), birth weight (±300 g), antenatal corticosteroids, sex and general anaesthesia. The primary outcome was breathing effort, assessed as minute volume (MV) of spontaneous breathing. We also measured tidal volume (Vt), respiratory rate (RR) and apnoea in the first 5 min and additional physiological parameters in the first 10 min after start of respiratory support.

Results Ninety-two infants were included (n=46 CCA infants vs n=46 controls; median (IQR) gestational age 26+4 (25+0–27+6) vs 26+6 (25+1–28+3) weeks). MV and Vt were significantly lower (MV: 43 (17–93) vs 70 (31–119) mL/kg/min, p=0.043; Vt: 2.6 (1.9–3.6) vs 2.9 (2.2–4.8) mL/kg/breath, p=0.046), whereas RR was similar in CCA infants compared with controls. Incidence of apnoea was higher (5 (2-6) vs 2 (1-4), p=0.002), and total duration of apnoea was longer (90 (21-139) vs 35 (12-98) s, p=0.025) in CCA infants. CCA infants took significantly longer to reach an oxygen saturation >80% (3:37 (2:10–4:29) vs 2:25 (1:06–3:52) min, p=0.016) and had a lower oxygen saturation at 5 min (77 (66–92) vs 91 (68–94) %, p=0.028), despite receiving more oxygen (62 (48-76) vs 54 (43-73) %, p=0.036).

Conclusion CCA is associated with reduced breathing effort and oxygenation in premature infants at birth.

  • intensive care units, neonatal
  • neonatology
  • resuscitation
  • Allergy and Immunology

Data availability statement

All data relevant to the study are included in the article or uploaded as supplementary information.

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Data availability statement

All data relevant to the study are included in the article or uploaded as supplementary information.

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  • Contributors All authors contributed to the conception and design of the study; TJRP and KLAMK contributed to data acquisition and data management; TJRP, KLAMK and ABtP contributed to data analysis; all authors were involved with the data interpretation; TJRP contributed to the draft formation; KLAMK, GRP, SBH, TvdA and ABtP contributed to revising the draft formation. TJRP accepts full responsibility as guarantor for the finshed work, conduct of the study and overall content. As guarantor, TJRP had access to the data, and controlled the decision to publish. All authors approved the final version of the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.