Skip to main content

Advertisement

SpringerLink
Log in

Early postnatal skin colour changes in term newborns with subclinical histological chorioamnionitis

  • Original Paper
  • Published:
European Journal of Pediatrics Aims and scope Submit manuscript

Abstract

Chorioamnionitis, a known risk factor for fetal and neonatal morbidity both in preterm and term newborns, is often subclinical. Earlier observations have linked skin colourimetry to neonatal illness severity and adverse neonatal outcome. Here, we tested the hypothesis that subclinical histological chorioamnionitis is associated with early postnatal skin colour changes in term newborns. Skin colourimetry on ten body sites (forehead, cheek, forearm, palm, upper chest, abdomen, back, buttock, leg, and sole) was examined in 45 term infants with subclinical histological chorioamnionitis and 45 sex- and gestational age-matched controls, using a tristimulus portable colourimeter at 1, 5 and 10 min after birth. Infants with subclinical histological chorioamnionitis showed statistically significant early postnatal skin colourimetric differences, in nine and seven out of the ten body sites examined as compared to control newborns at 1 min (P≤0.0092), 5 min (P≤0.0081) and 10 min (P≤0.0056) from birth, respectively. Skin colourimetry changes were associated with lower 1 min Apgar scores (P<0.0001), cord blood pH (P<0.0001), PaO2 (P<0.0001), and base excess (P<0.0001) values, together with higher cord blood PaCO2 (P=0.0001), NICU admissions (P=0.00076), endotracheal intubation in the delivery room (P=0.012), Neonatal Acute Physiology-Perinatal Extension (P<0.0001) and Neonatal Therapeutic Intervention Scoring System (P<0.0001) scores than the chorioamnionitis-negative infants. Conclusion:these findings, compatible with early peripheral microcirculatory changes, indicate skin vasoconstriction as an early neonatal manifestation of subclinical chorioamnionitis.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

Abbreviations

CA :

chorioamnionitis

NTISS :

Neonatal Therapeutic Intervention Scoring System

s-HCA :

subclinical histological chorioamnionitis

SNAP-PE :

Score for Neonatal Acute Physiology-Perinatal Extension

References

  1. Alexander JM, McIntire DM, Leveno KJ (1999) Chorioamnionitis and the prognosis for term infants. Obstet Gynecol 94: 274–278

    Article  CAS  PubMed  Google Scholar 

  2. Apgar V (1953) A proposal for a new method of evaluation of the newborn infant. Curr Res Anesth Analg 32: 260–267

    CAS  PubMed  Google Scholar 

  3. Casey BM, McIntire DD, Leveno KJ (2001) The continuing value of the Apgar score for the assessment of newborn infants. N Engl J Med 344: 519–520

    Article  PubMed  Google Scholar 

  4. De Felice C, Toti P, Picciolini E, Massafra C, Pecciarini L, Palmeri ML, Bracci R (1997) High incidence of histologic chorioamnionitis in women with gestational vaginal bleeding. Acta Obstet Gynecol Scand 76: 85–86

    PubMed  Google Scholar 

  5. De Felice C, Toti P, Laurini RN, Stumpo M, Picciolini E, Todros T, Tanganelli P, Buonocore G, Bracci R (2001) Early neonatal brain damage in histologic chorioamnionitis. J Pediatr 138: 101–104

    Article  PubMed  Google Scholar 

  6. De Felice C, Flori ML, Pellegrino M, Toti P, Stanghellini E, Molinu A, Tosi P, Bagnoli F (2002) Predictive value of skin color for illness severity in the high-risk newborn. Pediatr Res 51: 100–105

    PubMed  Google Scholar 

  7. De Felice C, Mazzieri S, Pellegrino M, Del Pasqua A, Toti P, Bagnoli F, Rosati E, Latini G (2004) Skin reflectance changes in preterm infants with patent ductus arteriosus. Early Hum Dev 78: 45–51

    Article  PubMed  Google Scholar 

  8. Del Moral T, Goldberg RN, Suguihara C, Martinez O, Feuer WJ, Bancalari E (1992) Effects of pentoxifylline on the cardiovascular manifestations of group B streptococcal sepsis in the piglet. Pediatr Res 31: 596–600

    PubMed  Google Scholar 

  9. Garland SM, Ni Chuileannain F, Satzke C, Robins-Browne R (2002) Mechanisms, organisms and markers of infection in pregnancy. J Reprod Immunol 57: 169–183

    Article  CAS  PubMed  Google Scholar 

  10. Gomez R, Romero R, Ghezzi F, Yoon BH, Mazor M, Berry SM (1998) The fetal inflammatory response syndrome. Am J Obstet Gynecol 179: 194–202

    CAS  PubMed  Google Scholar 

  11. Gray JE, Richardson DK, McCormick MC, Workman-Daniels K, Goldmann DA (1992) Neonatal therapeutic intervention scoring system: a therapy-based severity-of-illness index. Pediatrics 90: 561–567

    CAS  PubMed  Google Scholar 

  12. Grether JK, Nelson KB (1997) Maternal infection and cerebral palsy in infants of normal birth weight. JAMA 278: 207–211

    Article  CAS  PubMed  Google Scholar 

  13. Hagberg H, Wennerholm UB, Savman K (2002) Sequelae of chorioamnionitis. Curr Opin Infect Dis 15: 301–306

    PubMed  Google Scholar 

  14. Hankins GD, Snyder RR, Yeomans ER (1991) Umbilical arterial and venous acid-base and blood gas values and the effect of chorioamnionitis on those values in a cohort of preterm infants. Am J Obstet Gynecol 164: 1261–1264

    CAS  PubMed  Google Scholar 

  15. Herbst A, Wolner-Hanssen P, Ingemarsson I (1997) Risk factors for acidemia at birth. Obstet Gynecol. 90: 125–130

    Google Scholar 

  16. Kopola H, Lahti A, Myllylä RA, Hannuksela M (1993) Two-channel fiber optic skin erythema meter. Opt Eng 32: 222–226

    Google Scholar 

  17. Maberry MC, Ramin SM, Gilstrap LC 3rd, Leveno KJ, Dax JS (1990) Intrapartum asphyxia in pregnancies complicated by intra-amniotic infection. Obstet Gynecol 76: 351–354

    CAS  PubMed  Google Scholar 

  18. Meyer BA, Dickinson JE, Chambers C, Parisi VM (1992) The effect of fetal sepsis on umbilical cord blood gases. Am J Obstet Gynecol 166: 612–617

    CAS  PubMed  Google Scholar 

  19. Negishi H, Matsuda T, Okuyama K, Sutoh S, Fujioka Y, Fujimoto S (1998) Staphylococcus aureus causing chorioamnionitis and fetal death with intact membranes at term. A case report. J Reprod Med 43: 397–400

    CAS  PubMed  Google Scholar 

  20. Pöschl JMB, Weiss T, Fallahi F, Linderkamp O (1994) Reactive hyperemia of skin microcirculation in septic neonates. Acta Paediatr 83: 808–811

    PubMed  Google Scholar 

  21. Richardson DK, Phibbs CS, Gray JE, McCormick MC, Workman-Daniels K, Goldmann DA (1993) Birth weight and illness severity: independent predictors of neonatal mortality. Pediatrics 91: 969–975

    CAS  PubMed  Google Scholar 

  22. Robertson AR (1977) The CIE 1976 color-difference formulae. Color Res Appl 2: 7–11

    Google Scholar 

  23. Sebire NJ, Goldin RD, Regan L (2001) Histological chorioamnionitis in relation to clinical presentation at 14–40 weeks of gestation. J Obstet Gynaecol 21: 242–245

    Article  PubMed  Google Scholar 

  24. Shalak LF, Laptook AR, Jafri HS, Ramilo O, Perlman JM (2002) Clinical chorioamnionitis, elevated cytokines, and brain injury in term infants. Pediatrics 110: 673–680

    PubMed  Google Scholar 

  25. Toti P, De Felice C (2001) Chorioamnionitis and fetal/neonatal brain injury. Biol Neonate 79: 201–204

    Article  CAS  PubMed  Google Scholar 

  26. Toti P, De Felice C, Stumpo M, Schurfeld K, Di Leo L, Vatti R, Bianciardi G, Buonocore G, Seemayer TA, Luzi P (2000) Acute thymic involution in fetuses and neonates with chorioamnionitis. Hum Pathol 31: 1121–1128

    Article  CAS  PubMed  Google Scholar 

  27. Williams MC, O’Brien WF, Nelson RN, Spellacy WN (2000) Histologic chorioamnionitis is associated with fetal growth restriction in term and preterm infants. Am J Obstet Gynecol 183: 1094–1099

    Article  CAS  PubMed  Google Scholar 

  28. Willoughby RE Jr, Nelson KB (2002) Chorioamnionitis and brain injury. Clin Perinatol 29: 603–621

    PubMed  Google Scholar 

  29. Wu YW, Escobar GJ, Grether JK, Croen LA, Greene JD, Newman TB (2003) Chorioamnionitis and cerebral palsy in term and near-term infants. JAMA 290: 2677–2684

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Neonatal Intensive Care Unit, Azienda Ospedaliera Universitaria Senese, Siena, Italy

    Claudio De Felice

  2. Division of Neonatology, Perrino Hospital, Brindisi, Italy

    Paola Vacca, Antonio Del Vecchio & Giuseppe Latini

  3. Pathology Unit, Perrino Hospital, Brindisi, Italy

    Mario Criscuolo & Antonia Lozupone

  4. Clinical Physiology Institute (IFC-CNR), National Research Council of Italy, Lecce Section, s.s. 7 per Mesagne, 72100 , Brindisi, Italy

    Giuseppe Latini

Authors
  1. Claudio De Felice
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Paola Vacca
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Antonio Del Vecchio
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Mario Criscuolo
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Antonia Lozupone
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Giuseppe Latini
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Giuseppe Latini.

Rights and permissions

Reprints and permissions

About this article

Cite this article

De Felice, C., Vacca, P., Del Vecchio, A. et al. Early postnatal skin colour changes in term newborns with subclinical histological chorioamnionitis. Eur J Pediatr 163, 550–554 (2004). https://doi.org/10.1007/s00431-004-1488-8

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00431-004-1488-8

Keywords

Search

Navigation