A gestation-dependent association between chorioamnionitis and early transepidermal water loss in extremely preterm infants.

BACKGROUND

To determine whether chorioamnionitis-exposure in extremely preterm infants was associated with higher transepidermal water loss (TEWL) and to explore whether this relationship varied by gestational age, placental histopathology and illness severity.

METHODS

In this prospective single-centre cohort study, infants ≤27+6 weeks' gestational age underwent closed-chamber TEWL measurement on days 1, 3 and 14 in humidified incubators utilizing standardized methodology. Infants were classified according to placental histopathology and inflammation severity. Interactions assessed included gestational and postnatal age, and illness acuity.

RESULTS

Thirty-seven infants were included, 13 of which had histological chorioamnionitis. Chorioamnionitis was associated with higher day-one TEWL; however, this was no longer significant after gestational adjustment (p = 0.152). A significant gestation-by-chorioamnionitis interaction was confined to the most immature infants (p = 0.017). In this cohort, higher TEWL was associated with a placental inflammatory response and postnatal instability. Adjusted TEWL declined from days 1 to 14, with the greatest between-group difference on day-one.

CONCLUSION

In this exploratory cohort, the association between histological chorioamnionitis and early TEWL was modified by gestational age, with higher TEWL observed among the most immature exposed infants. These hypothesis-generating findings suggest that fetal inflammation and early physiological instability may both contribute to impaired barrier adaptation.

IMPACT: Chorioamnionitis-exposure and epidermal immaturity are frequent hallmarks of extreme prematurity. Although several morbidities have been attributed to chorioamnionitis, a skin component remains unclear. We report a gestation-dependent association between chorioamnionitis and skin integrity, most evident in infants at or below approximately 25 weeks' gestational age. A fetal inflammatory response may contribute to both elevated transepidermal water loss and postnatal instability, suggesting these may contribute alongside immaturity to impaired barrier function in the most preterm infants. Our findings suggest extremely preterm infants exposed to intrauterine inflammation may be uniquely vulnerable to fluid imbalance or skin injury owing to compromised barrier integrity.