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Journal of Perinatal Medicine

Official Journal of the World Association of Perinatal Medicine

Editor-in-Chief: Dudenhausen, MD, FRCOG, Joachim W.

Ed. by Bancalari, Eduardo / Chappelle, Joseph / Chervenak, Frank A. / D'Addario , Vincenzo / Genc, Mehmet R. / Greenough, Anne / Grunebaum, Amos / Konje, Justin C. / Kurjak M.D., Asim / Romero, Roberto / Zalud, MD PhD, Ivica

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Volume 46, Issue 1


The combined exposure to intra-amniotic inflammation and neonatal respiratory distress syndrome increases the risk of intraventricular hemorrhage in preterm neonates

Kyung Joon Oh
  • Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Korea
  • Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, Seongnam-si, Korea
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/ Jee Yoon Park
  • Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Korea
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/ JoonHo Lee / Joon-Seok Hong
  • Corresponding author
  • Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Korea
  • Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, Seongnam-si, Korea
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/ Roberto Romero
  • Perinatology Research Branch, NICHD/NIH/DHHS, Bethesda, MD, USA, and Detroit, MI, USA
  • Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI, USA
  • Department of Epidemiology and Biostatistics, Michigan State University, East Lansing, MI, USA
  • Center for Molecular Medicine and Genetics, Wayne State University, Detroit, MI, USA
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/ Bo Hyun Yoon
  • Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Korea
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Published Online: 2017-06-26 | DOI: https://doi.org/10.1515/jpm-2016-0348



To evaluate the impact of combined exposure to intra-amniotic inflammation and neonatal respiratory distress syndrome (RDS) on the development of intraventricular hemorrhage (IVH) in preterm neonates.


This retrospective cohort study includes 207 consecutive preterm births (24.0–33.0 weeks of gestation). Intra-amniotic inflammation was defined as an amniotic fluid matrix metalloproteinase-8 concentration >23 ng/mL. According to McMenamin’s classification, IVH was defined as grade II or higher when detected by neurosonography within the first weeks of life.


(1) IVH was diagnosed in 6.8% (14/207) of neonates in the study population; (2) IVH was frequent among newborns exposed to intra-amniotic inflammation when followed by postnatal RDS [33% (6/18)]. The frequency of IVH was 7% (8/115) among neonates exposed to either of these conditions – intra-amniotic inflammation or RDS – and 0% (0/64) among those who were not exposed to these conditions; and (3) Neonates exposed to intra-amniotic inflammation and postnatal RDS had a significantly higher risk of IVH than those with only intra-amniotic inflammation [odds ratio (OR) 4.6, 95% confidence interval (CI) 1.1–19.3] and those with RDS alone (OR 5.6, 95% CI 1.0–30.9), after adjusting for gestational age.


The combined exposure to intra-amniotic inflammation and postnatal RDS markedly increased the risk of IVH in preterm neonates.

Keywords: Brain injury; hypoxic-ischemic injury; intra-amniotic inflammation; periventricular-intraventricular hemorrhage; preterm birth


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About the article

Corresponding author: Joon-Seok Hong, MD, PhD, Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, 13620, Korea, Phone: +82-31-787-7256, Fax: +82-31-787-4054

Received: 2016-11-01

Accepted: 2017-01-12

Published Online: 2017-06-26

Published in Print: 2018-01-26

Author’s statement

Conflict of interest: Authors state no conflict of interest.

Material and methods: Informed consent: Informed consent has been obtained from all individuals included in this study.

Ethical approval: The research related to human subject use has complied with all the relevant national regulations, and institutional policies, and is in accordance with the tenets of the Helsinki Declaration, and has been approved by the authors’ institutional review board or equivalent committee.

Citation Information: Journal of Perinatal Medicine, Volume 46, Issue 1, Pages 9–20, ISSN (Online) 1619-3997, ISSN (Print) 0300-5577, DOI: https://doi.org/10.1515/jpm-2016-0348.

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