Differences among Acute, Subacute, and Chronic Chorioamnionitis Based on Levels of Inflammation-Associated Proteins in Cord Blood

Abstract

The serum concentration of inflammation-associated proteins and several complement components in the cord blood of 215 newborns with and without chorioamnionitis (CAM), who were delivered between 17 and 42 weeks of gestation, were measured. We investigated the relationship of levels of serum proteins to acute, subacute, and chronic CAM, and to subacute necrotizing funisitis (SNF). Complement components C3d, C3, and C4 levels increased in subacute CAM ( P = 0.0002, P = 0.0007, P = 0.0029, respectively), whereas factor B increased in each type of CAM ( P = 0.0001, P = 0.0009, P = 0.0004, respectively). Among the immunoglobulins, IgG levels were unrelated to the presence or type of CAM, IgM levels increased in subacute CAM ( P < 0.0001), and IgA levels increased in chronic CAM ( P < 0.0001). Among the acute phase reactants (APR), haptoglobin and C-reactive protein (CRP) levels increased in acute ( P < 0.0001, P = 0.0022, respectively) and chronic CAM ( P = 0.0035, P = 0.0345, respectively), whereas orosomucoid levels increased in chronic CAM ( P = 0.0003). IL-6 levels increased in acute ( P = 0.0011) and subacute ( P = 0.0475) CAM. C3d ( P = 0.0063), C3 ( P = 0.0289), C4 ( P = 0.0491), and IgM ( P < 0.0001) levels were increased in SNF. These findings suggest that the histologic distinction of acute, subacute, and chronic CAM is a useful indicator of the inflammatory mediator status of the infants. The infants with SNF may have ended their initial active inflammatory states, but they still have subacute immune activation.