53
views
0
recommends
+1 Recommend
0 collections
    0
    shares
      • Record: found
      • Abstract: found
      • Article: found
      Is Open Access

      The fetal inflammatory response syndrome: the origins of a concept, pathophysiology, diagnosis, and obstetrical implications

      research-article
      a , b , a , c , d , e , f , g , * , a , b , a , b , a , b , a , b , a , b , a , b , a , b , h , a , i , a , j , a , b , a , b , k
      Seminars in fetal & neonatal medicine
      Cerebral palsy, Chorioamnionitis, Congenital dermatitis, Cytokines, Fetal cytokine release syndrome, Fetal cytokine storm, Fetal hematophagocytic syndrome, Fetal macrophage activation-like syndrome, FIRS, Funisitis, Interleukin-6, Intra-amniotic infection, Intra-amniotic inflammation, Neonatal encephalopathy, Neonatal morbidity, Neonatal sepsis, Neuroinflammation perinatal morbidity, Prematurity, Premature birth, Preterm labor, Preterm prelabor rupture of the membranes (preterm PROM), Retinopathy of prematurity, Sensorineuronal hearing loss

      Read this article at

      Bookmark
          There is no author summary for this article yet. Authors can add summaries to their articles on ScienceOpen to make them more accessible to a non-specialist audience.

          Abstract

          The fetus can deploy a local or systemic inflammatory response when exposed to microorganisms or, alternatively, to non-infection-related stimuli (e.g., danger signals or alarmins). The term “Fetal Inflammatory Response Syndrome” (FIRS) was coined to describe a condition characterized by evidence of a systemic inflammatory response, frequently a result of the activation of the innate limb of the immune response. FIRS can be diagnosed by an increased concentration of umbilical cord plasma or serum acute phase reactants such as C-reactive protein or cytokines (e.g., interleukin-6). Pathologic evidence of a systemic fetal inflammatory response indicates the presence of funisitis or chorionic vasculitis. FIRS was first described in patients at risk for intraamniotic infection who presented preterm labor with intact membranes or preterm prelabor rupture of the membranes. However, FIRS can also be observed in patients with sterile intra-amniotic inflammation, alloimmunization (e.g., Rh disease), and active autoimmune disorders. Neonates born with FIRS have a higher rate of complications, such as early-onset neonatal sepsis, intraventricular hemorrhage, periventricular leukomalacia, and death, than those born without FIRS. Survivors are at risk for long-term sequelae that may include bronchopulmonary dysplasia, neurodevelopmental disorders, such as cerebral palsy, retinopathy of prematurity, and sensorineuronal hearing loss. Experimental FIRS can be induced by intra-amniotic administration of bacteria, microbial products (such as endotoxin), or inflammatory cytokines (such as interleukin-1), and animal models have provided important insights about the mechanisms responsible for multiple organ involvement and dysfunction. A systemic fetal inflammatory response is thought to be adaptive, but, on occasion, may become dysregulated whereby a fetal cytokine storm ensues and can lead to multiple organ dysfunction and even fetal death if delivery does not occur (“rescued by birth”). Thus, the onset of preterm labor in this context can be considered to have survival value. The evidence so far suggests that FIRS may compound the effects of immaturity and neonatal inflammation, thus increasing the risk of neonatal complications and long-term morbidity. Modulation of a dysregulated fetal inflammatory response by the administration of antimicrobial agents, anti-inflammatory agents, or cell-based therapy holds promise to reduce infant morbidity and mortality.

          Related collections

          Most cited references419

          • Record: found
          • Abstract: found
          • Article: found

          The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3).

          Definitions of sepsis and septic shock were last revised in 2001. Considerable advances have since been made into the pathobiology (changes in organ function, morphology, cell biology, biochemistry, immunology, and circulation), management, and epidemiology of sepsis, suggesting the need for reexamination.
            Bookmark
            • Record: found
            • Abstract: found
            • Article: not found

            The trinity of COVID-19: immunity, inflammation and intervention

            Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the causative agent of the ongoing coronavirus disease 2019 (COVID-19) pandemic. Alongside investigations into the virology of SARS-CoV-2, understanding the fundamental physiological and immunological processes underlying the clinical manifestations of COVID-19 is vital for the identification and rational design of effective therapies. Here, we provide an overview of the pathophysiology of SARS-CoV-2 infection. We describe the interaction of SARS-CoV-2 with the immune system and the subsequent contribution of dysfunctional immune responses to disease progression. From nascent reports describing SARS-CoV-2, we make inferences on the basis of the parallel pathophysiological and immunological features of the other human coronaviruses targeting the lower respiratory tract — severe acute respiratory syndrome coronavirus (SARS-CoV) and Middle East respiratory syndrome coronavirus (MERS-CoV). Finally, we highlight the implications of these approaches for potential therapeutic interventions that target viral infection and/or immunoregulation.
              Bookmark
              • Record: found
              • Abstract: found
              • Article: found

              Pharmacologic Treatments for Coronavirus Disease 2019 (COVID-19): A Review

              The pandemic of coronavirus disease 2019 (COVID-19) caused by the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) presents an unprecedented challenge to identify effective drugs for prevention and treatment. Given the rapid pace of scientific discovery and clinical data generated by the large number of people rapidly infected by SARS-CoV-2, clinicians need accurate evidence regarding effective medical treatments for this infection.
                Bookmark

                Author and article information

                Journal
                101240003
                32254
                Semin Fetal Neonatal Med
                Semin Fetal Neonatal Med
                Seminars in fetal & neonatal medicine
                1744-165X
                1878-0946
                10 October 2023
                August 2020
                23 October 2020
                17 October 2023
                : 25
                : 4
                : 101146
                Affiliations
                [a ]Perinatology Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, U.S. Department of Health and Human Services (NICHD/NIH/DHHS), Bethesda, MD, and Detroit, MI, USA
                [b ]Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, MI, USA
                [c ]Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI, USA
                [d ]Department of Epidemiology and Biostatistics, Michigan State University, East Lansing, MI, USA
                [e ]Center for Molecular Medicine and Genetics, Wayne State University, Detroit, MI, USA
                [f ]Detroit Medical Center, Detroit, MI, USA
                [g ]Department of Obstetrics and Gynecology, Florida International University, Miami, FL, USA
                [h ]Department of Biochemistry, Microbiology and Immunology, Wayne State University School of Medicine, Detroit, MI, USA
                [i ]Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Republic of Korea
                [j ]Department of Pathology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
                [k ]Department of Physiology, Wayne State University School of Medicine, Detroit, MI, USA
                Author notes
                [* ]Corresponding author. Perinatology Research Branch, NICHD/NIH/DHHS, Hutzel Women’s Hospital, 3990 John R Street, 4 Brush, Detroit, MI 48201, USA. prbchiefstaff@ 123456med.wayne.edu (R. Romero).
                Article
                NIHMS1624287
                10.1016/j.siny.2020.101146
                10580248
                33164775
                1c392b09-c7b1-456d-8520-42687c833bb8

                This is an open access article under the CC BY-NC-ND license ( http://creativecommons.org/licenses/by-nc-nd/4.0/).

                History
                Categories
                Article

                cerebral palsy,chorioamnionitis,congenital dermatitis,cytokines,fetal cytokine release syndrome,fetal cytokine storm,fetal hematophagocytic syndrome,fetal macrophage activation-like syndrome,firs,funisitis,interleukin-6,intra-amniotic infection,intra-amniotic inflammation,neonatal encephalopathy,neonatal morbidity,neonatal sepsis,neuroinflammation perinatal morbidity,prematurity,premature birth,preterm labor,preterm prelabor rupture of the membranes (preterm prom),retinopathy of prematurity,sensorineuronal hearing loss

                Comments

                Comment on this article

                scite_
                0
                0
                0
                0
                Smart Citations
                0
                0
                0
                0
                Citing PublicationsSupportingMentioningContrasting
                View Citations

                See how this article has been cited at scite.ai

                scite shows how a scientific paper has been cited by providing the context of the citation, a classification describing whether it supports, mentions, or contrasts the cited claim, and a label indicating in which section the citation was made.

                Similar content47

                Cited by69

                Most referenced authors4,492