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Preterm birth, infection, and inflammation in the


American Journal of Obstetrics and Gynecology
This month, the journal contains articles presented at istration of bacterial endotoxin predisposes to a
the Annual Meeting of the American Gynecological and more rapid reduction in base excess, and therefore
Obstetrical Society (AGOS), in addition to manuscripts propose that inflammation increases the vulnera-
accepted through the standard process of the journal. bility to a hypoxic insult in newborn piglets. These
Those that were presented at the AGOS meeting include findings provide a mechanism to explain the asso-
a commentary by a leader in the field, as well as the lead ciation between chorioamnionitis, neonatal hy-
author’s reply. poxic ischemic encephalopathy, and cerebral
Several articles contribute to the understanding of the palsy.
relationship between infection/inflammation and pre- 4. Hasegawa et al (on page 1038)4 report that the
term birth. This brief summary highlights relevant transcervical administration of lactoferrin, a natu-
material published in this issue. ral antimicrobial protein, to pregnant rabbits
inoculated with Escherichia coli improved fetal
1. Ramsey et al (on page 1162)1 provide evidence that survival and prolonged pregnancy. These observa-
the development of clinical chorioamnionitis in tions suggest that some intrauterine infections may
patients with preterm PROM increases the risk of be amenable to treatment with natural antimicro-
major neonatal morbidity (composite outcome). bial and anti-inflammatory products.
This study, collectively with other reports, justifies 5. Carey and Klebanoff (on page 1343)5 have con-
the need to assess the optimal method for the ducted a study that explores why metronidazole
management of patients with preterm PROM treatment has been reported to increase the rate of
(delivery vs expectant management), methods for spontaneous preterm birth in patients with Trich-
determining the risk of infection/inflammation, and omonas vaginalis with and without bacterial vag-
whether interventions such as antibiotics and agents inosis. They propose that metronidazole therapy
that modulate the inflammatory response may before 32 weeks is associated with changes in the
prevent chorioamnionitis and neonatal morbidity. vaginal flora characterized by an increase in the
2. Moss et al (on page 1179)2 report that the intro- E coli and Klebsiella pneumoniae microbial burden
duction of Ureaplasma species into the amniotic (‘‘heavy growth’’), and these patients had an
cavity of pregnant sheep led to a chronic inflam- increased risk for preterm delivery. Readers are
matory process that resulted in fetal growth re- referred to the insightful discussion between Dr
striction, aspiration of the microorganism into the Robert Goldenberg and the authors presented at
fetal lung, and fetal lung inflammation. This was the end of the article.
accompanied by increased production of surfac- 6. Chen et al (page 1167)6 report the results of a time-
tant lipids and surfactant mRNA expression for trend study that found that the implementation of
surfactant proteins A, B, and C. Of interest is that an intrapartum antibiotic prophylaxis for group B
inoculation with Ureaplasma species did not result Streptococcus was associated with a reduction in
in preterm labor and preterm PROM in pregnant the rate of early-onset neonatal sepsis due to GBS
sheep, but was associated with a chronic inflam- but not with an increase in the rate of antibiotic-
matory state, which affected fetal growth and lung resistant GBS early sepsis. This study reports the
development. rate of GBS early sepsis during a period of time
3. Lyng et al (on page 1172)3 present experimental when there was no protocol for GBS prophylaxis
evidence that inflammation induced by the admin- and when two protocols were implemented: a

0002-9378/$ - see front matter Ó 2005 Elsevier Inc. All rights reserved.
doi:10.1016/j.ajog.2005.03.009
risk-based protocol followed by a screening-based 3. Lyng K, Braakhuis M, Frøen JF, Stray-Pedersen B, Saugstad OD.
protocol. Inflammation increases vulnerability to hypoxia in newborn piglets.
Effect of reoxygenation with 21% and 100% O2. Am J Obstet
Gynecol 2005;192:1172-8.
Roberto Romero, MD 4. Hasegawa A, Otsuki K, Sasaki Y, Sawada M, Mitsukawa K, Chiba
Thomas Garite, MD H, Nagatsuka M, Okai T, Kato A. Preventive effect of recombinant
human lactoferrin in a rabbit preterm delivery model. Am J Obstet
References Gynecol 2005;1038-43.
5. Carey JC, Klebanoff MA. Is a change in the vaginal flora associated
1. Ramsey PS, Lieman JM, Brumfield CG, Carlo W. Chorioamnio- with an increased risk of preterm birth? Am J Obstet Gynecol
nitis increases neonatal morbidity in pregnancies complicated by 2005;192:1343-9.
preterm premature rupture of membranes (PPROM). Am J Obstet 6. Chen KT, Puopolo KM, Eichenwald EC, Onderdonk AB,
Gynecol 2005;192:1162-6. Lieberman E. No increase in rates of early-onset neonatal sepsis
2. Moss TJM, Nitsos I, Ikegami M, Jobe AH, Newnham JP. Exper- by antibiotic-resistant group B Streptococcus in the era of
imental intra-uterine Ureaplasma infection in sheep. Am J Obstet intrapartum antibiotic prophylaxis. Am J Obstet Gynecol 2005;
Gynecol 2005;192:1179-86. 192:1167-71.

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