Chorioamnionitis appears not to be a Risk Factor for Patent Ductus Arteriosus in Preterm Infants: A Systematic Review and Meta-Analysis.

Elham Behbodi,Eduardo Villamor,Eduardo Villamor-Martínez,Pieter L J Degraeuwe

doi:10.1038/srep37967

Elham Behbodi, Eduardo Villamor + Show 2 more

Open Access

https://doi.org/10.1038/srep37967

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Journal: Scientific Reports	Publication Date: Nov 28, 2016
Citations: 32	License type: CC BY 4.0

Affiliation: Maastricht University

Abstract

The contribution of chorioamnionitis (CA) to mortality and morbidity in preterm infants is difficult to assess because observational studies frequently present significant differences in baseline characteristics of the infants exposed or non-exposed to CA. In an attempt to perform a thorough assessment of the possible association between CA and patent ductus arteriosus (PDA) in preterm infants, we conducted a meta-analysis in which adjusted odds ratios (ORs) were pooled and we analyzed the effects of potential confounders, such as gestational age (GA) or birth weight (BW). We identified 45 relevant studies (27186 patients, 7742 CA cases). Random effects meta-analysis of crude ORs showed a significant positive association between CA and PDA (OR 1.352, 95% CI 1.172 to 1.560). Adjusted ORs were reported in 11 studies (19577 infants). Meta-analysis of these studies showed a significant negative association between CA and PDA (OR 0.802, 95% CI 0.751 to 0.959). Meta-regression showed that the differences in GA or BW between the CA-exposed and non-exposed groups were significantly correlated with the effect size of the association between PDA and CA. In conclusion, our study confirms that confounders need to be taken into account when assessing the association between CA and clinical outcomes in preterm infants.

Highlights

The contribution of chorioamnionitis (CA) to mortality and morbidity in preterm infants is difficult to assess because observational studies frequently present significant differences in baseline characteristics of the infants exposed or non-exposed to CA
While all studies provided data to measure the association between CA and patent ductus arteriosus (PDA), none of the studies was primarily designed to assess this association
There is a substantial body of evidence supporting that CA is a major risk factor for spontaneous preterm birth but the independent contribution of CA to prematurity-associated mortality and morbidity is much more difficult to assess[3]

Summary

Introduction

The contribution of chorioamnionitis (CA) to mortality and morbidity in preterm infants is difficult to assess because observational studies frequently present significant differences in baseline characteristics of the infants exposed or non-exposed to CA. In an attempt to perform a thorough assessment of the possible association between CA and patent ductus arteriosus (PDA) in preterm infants, we conducted a meta-analysis in which adjusted odds ratios (ORs) were pooled and we analyzed the effects of potential confounders, such as gestational age (GA) or birth weight (BW). Observational studies comparing the outcomes of infants with and without CA are, comparing the effects of placental infection/inflammation with vascular placental pathology[10,21] This may result in significant differences between the CA and the “control” group in terms of, for example, GA, birth weight (BW), or use of antenatal corticosteroids[10,20,21,22].

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