# Funisitis Predicts Poor Respiratory Outcomes in Extremely Preterm Neonates

## TL;DR

Funisitis in extremely preterm infants is linked to worse respiratory outcomes, despite some protective effects against respiratory distress syndrome.

## Contribution

This study identifies funisitis as an independent predictor of poor respiratory outcomes in extremely preterm neonates.

## Key findings

- Neonates with funisitis had lower gestational age and higher clinical chorioamnionitis rates.
- Funisitis was associated with increased risk of chronic lung disease and cystic-interstitial lung changes.
- Anti-inflammatory therapy may improve outcomes if funisitis is identified early.

## Abstract

What are the main findings?
•Neonates with histological chorioamnionitis (HCAM) and funisitis had a lower gestational age and a higher incidence of clinical chorioamnionitis.•Extremely preterm neonates with funisitis were associated with a markedly greater protection effect on respiratory distress syndrome but a higher risk to develop early cystic-interstitial lung and chronic lung disease than HCAM.

Neonates with histological chorioamnionitis (HCAM) and funisitis had a lower gestational age and a higher incidence of clinical chorioamnionitis.

Extremely preterm neonates with funisitis were associated with a markedly greater protection effect on respiratory distress syndrome but a higher risk to develop early cystic-interstitial lung and chronic lung disease than HCAM.

What are the implications of the main findings?
•Extremely preterm neonates with funisitis will have poor respiratory outcomes. The identification of predictive approaches for funisitis and the timely initiation of anti-inflammatory therapy may contribute to improved respiratory outcomes

Extremely preterm neonates with funisitis will have poor respiratory outcomes. The identification of predictive approaches for funisitis and the timely initiation of anti-inflammatory therapy may contribute to improved respiratory outcomes

Background/Objectives: Histological chorioamnionitis (HCAM) is a risk factor of chronic lung disease (CLD) in preterm neonates. Funisitis, an indicator of fetal inflammatory response, has been linked to adverse neonatal outcomes, but its impact on respiratory outcomes in extremely preterm neonates remains uncertain. In this study, we investigated whether HCAM with funisitis is associated with poorer respiratory outcomes when compared with HCAM alone in preterm (gestational age 22–36 weeks) neonates. Methods: This was a retrospective cohort study. We divided very low-birth weight (VLBW) preterm neonates with placenta histopathology examinations into three groups—normal, isolated HCAM, and HCAM with funisitis. Perinatal characteristics, radiographic findings, morbidities, and respiratory outcomes were compared. Results: Among 244 VLBW neonates, 25 (10.2%) had HCAM with funisitis, 88 (36.1%) had isolated HCAM, and the remaining 131 were in the normal group. Neonates with HCAM and funisitis had a significantly lower gestational age (26.44 ± 2.1 weeks) but a higher incidence of clinical chorioamnionitis (40.0%) than those with isolated HCAM (12.5%) or normal placentas (6.9%). Moreover, the incidence of cystic–interstitial lung changes before 2 weeks of postnatal age was higher in the HCAM with funisitis group (56.5%) than in the isolated HCAM group (25.0%), and the normal group (4.4%). CLD occurred in 66.7%, 37.7%, and 1.3% of these groups, respectively, and the need for home oxygen at follow-up was 26.1%, 13.7%, and 6.4%. Both isolated HCAM and HCAM with funisitis protected against severe respiratory distress syndrome. However, extremely preterm birth and funisitis had a more adverse impact on CLD development than HCAM alone (adjusted odds ratio 15.259 vs. 3.841). Conclusions: Funisitis independently predicts poor respiratory outcomes in extremely preterm infants. The long-term clinical impacts of funisitis in preterm infants should be further investigated.