TOPLINE:

In children born very preterm after preterm labour or preterm premature rupture of membranes, isolated histologic chorioamnionitis — placental inflammation without maternal clinical symptoms — was not associated with an increased risk for neurodevelopmental disabilities by 5 years of age.

METHODOLOGY:

• Researchers conducted a secondary analysis of EPIPAGE 2, a French national cohort study, to evaluate the association between isolated histologic chorioamnionitis and neurodevelopmental disabilities at 5 years of age in children born very preterm.
• They included 1296 children born alive between 24 weeks 0 days and 31 weeks 6 days of gestation from singleton or twin pregnancies after preterm labour with intact membranes or preterm premature rupture of membranes (defined as membrane rupture > 24 hours before delivery).
• The primary outcome was neurodevelopmental disability, a composite of cerebral palsy, developmental coordination disorders, sensory and cognitive impairments, and behavioural difficulties, assessed at 5 years of age.

TAKEAWAY:

• Among survivors at 5 years, 486 children (36.3%) were exposed to isolated histologic chorioamnionitis.
• Mild neurodevelopmental disabilities were reported in 47.0% of children exposed to isolated histologic chorioamnionitis vs 33.6% of unexposed children.
• At 5 year of age, isolated histologic chorioamnionitis was not associated with the occurrence of mild disabilities (adjusted odds ratio [aOR], 1.0; 95% CI, 0.7-1.4) or moderate-to-severe neurodevelopmental disabilities (aOR, 0.9; 95% CI, 0.6-1.2).
• No significant associations were seen between isolated histologic chorioamnionitis and the occurrence of cerebral palsy, developmental coordination disorders, or cognitive disabilities.

IN PRACTICE:

"These results need to be confirmed by studying other components of perinatal inflammation in the context of PTL [preterm labour], PPROM [preterm premature rupture of membranes], or early-onset neonatal infection associated with a strong inflammatory response," the authors wrote.

SOURCE:

The study was led by Fanny Salmon, CRESS, Obstetric, Perinatal, and Paediatric Life Course Epidemiology, OPPaLE Team, INSERM, Paris, France. It was published online on August 19, 2025, in the Archives of Disease in Childhood Fetal & Neonatal Edition.

LIMITATIONS:

Approximately 29% of children were lost to follow-up at 5 years. The exclusion of children lost to follow-up may have led to an overestimation of the association between histologic chorioamnionitis and neurodevelopmental outcomes at 5 years of age in children born very preterm. Placental histology data were unavailable for 35.9% of eligible infants born at higher gestational ages.

DISCLOSURES:

The EPIPAGE 2 study was funded with support from the French Institute of Public Health Research/Institute of Public Health and its partners. The authors declared no competing interests.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.