Factors associated with cord blood CRP in patients with chorioamnionitis complicating early preterm birth

Chorioamnionitis (CA) and specifically funisitis have been associated with neonatal morbidity and mortality. Our study seeks to explore the association between antepartum exposures, the duration of CA, and a biomarker for inflammation. A secondary analysis was performed from a randomized controlled trial enrolling singleton pregnancies delivering at < 30 weeks’ gestation. Duration of maternal CA and prenatal therapeutic interventions were recorded. Patients were divided into three groups: No diagnosis of CA, histologic CA without funisitis, and histologic CA with funisitis. Antenatal factors were related to cord blood and neonatal CRP on day of life 1 (DOL1) between groups. 152 patients were included: 60 with histologic CA: 36 with and 24 without funisitis. Histologic CA was significantly associated with elevated umbilical cord CRP, P=.01, and neonatal CRP level on DOL1, P< .0001. In contrast, in cases of clinical CA (n=15, all with confirmed histology), the duration of diagnosis was not statistically correlated with cord blood CRP levels or neonatal serum on DOL1. A higher proportion of patients with histologic CA received prenatal indomethacin, P< .05, but similar exposures to antenatal steroids and magnesium sulfate were present, Table 1. In the subgroup with CA without funisitis, the cord blood CRP did not differ between indomethacin exposure groups, P=.25. The number of antenatal indomethacin doses within one week of delivery was not significantly related to cord blood CRP concentration in any of the subgroups, see Figure 1. The presence of histologic CA and funisitis was associated with higher levels of CRP. Antenatal indomethacin dosing did not appear to reduce a biomarker of fetal inflammation, but further study of this intervention may be warranted given our small sample size.View Large Image Figure ViewerDownload Hi-res image Download (PPT)