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

Behbodi, Elham; Villamor-Martínez, Eduardo; Degraeuwe, Pieter; Villamor, Eduardo

doi:10.1038/srep37967

Cited by 35 publications

(69 citation statements)

References 72 publications

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“…The present meta-regression demonstrated that the studies with higher differences in GA and BW between the CAexposed and CA-unexposed group were also the studies where infants with CA had a greater risk of ROP. Previous meta-regression analyses found a similar correlation between the differences in GA and BW and the CA-associated risk of BPD [7] and PDA [10].…”

Section: Discussionsupporting

confidence: 55%

“…Previous meta-analyses on the relationship between CA and BPD [7], or cerebral palsy [12], showed that the positive association observed with unadjusted data was significantly reduced, or became non-significant, when adjusted data were pooled. Moreover, in another meta-analysis, the significant positive association between CA and PDA became a significant negative association when only adjusted data were taken into consideration [10]. As mentioned in the introduction, in their meta-analysis on CA and ROP, Mitra, Aune (28) did not pool the studies with adjusted results but performed a subgroup analysis of studies which did not show a significant difference in GA between the CA-exposed and CA-unexposed group.…”

Section: Discussionmentioning

confidence: 99%

“…Chorioamnionitis (CA) is a major risk factor for preterm birth, especially at earlier gestational age (GA), and a major contributor to prematurity-associated morbidity and mortality [1][2][3][4][5]. The pathogenetic role of CA in the development of adverse outcomes of prematurity, such as bronchopulmonary dysplasia (BPD) [6,7], necrotizing enterocolitis (NEC) [8], patent ductus arteriosus (PDA) [9,10], neonatal brain injury [11], or cerebral palsy [12], has been addressed in a number of cohort and case-control studies, which have been summarized in systematic reviews. Nevertheless, it is still controversial whether the effects of CA on neonatal mortality and morbidity are related to infection/inflammation or to the role of CA as an etiological factor for very preterm birth [1][2][3][4][5].…”

Section: Introductionmentioning

confidence: 99%

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Chorioamnionitis as a risk factor for retinopathy of prematurity: an updated systematic review and meta-analysis

Villamor-Martínez

Cavallaro

Raffaeli

et al. 2018

Preprint

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The role of chorioamnionitis (CA) in the development of retinopathy of prematurity (ROP) is difficult to establish, because CA-exposed and CA-unexposed infants frequently present different baseline characteristics. We performed an updated systematic review and meta-analysis of studies reporting on the association between CA and ROP. We searched PubMed and EMBASE for relevant articles. Studies were included if they examined preterm or very low birth weight (VLBW, <1500g) infants and reported primary data that could be used to measure the association between exposure to CA and the presence of ROP. Of 748 potentially relevant studies, 50 studies met the inclusion criteria (38,986 infants, 9,258 CA cases). Meta-analysis showed a significant positive association between CA and any stage ROP (odds ratio [OR] 1.39, 95% confidence interval [CI] 1.11 to 1.74). CA was also associated with severe (stage ≥3) ROP (OR 1.63, 95% CI 1.41 to 1.89). Exposure to funisitis was associated with a higher risk of ROP than exposure to CA in the absence of funisitis. Additional meta-analyses showed that infants exposed to CA had lower gestational age (GA) and lower birth weight (BW). Meta-regression showed that lower GA and BW in the CAexposed group was significantly associated with a higher risk of ROP. In conclusion, our study confirms that CA is a risk factor for developing ROP. However, part of the effects of CA on the pathogenesis of ROP may be mediated by the role of CA as an etiological factor for very preterm birth.

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Section: Discussionsupporting

confidence: 55%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Chorioamnionitis as a risk factor for retinopathy of prematurity: an updated systematic review and meta-analysis

Villamor-Martínez

Cavallaro

Raffaeli

et al. 2018

Preprint

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“…98 In contrast, in our large multicenter study, after adjusting for confounders, we found that the risk of PDA was significantly lower among infants exposed to CCA (adjusted OR 0.831, 95% CI 0.711-0.971; P=0.02). 11 However, a recent meta-regression analysis by Behbodi et al 99 concluded that the differences in GA or BW between the CA-exposed and nonexposed groups were significantly correlated with the effect size of the association between CA and PDA and, consequently, CA appears not to be a risk factor for PDA in preterm infants (Table 4). …”

Section: Patent Ductus Arteriosusmentioning

confidence: 99%

Chorioamnionitis and neonatal morbidity: current perspectives

Henríquez¹,

Rodrigo²

2017

RRN

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Abstract:The term chorioamnionitis (CA) is commonly used to refer to different clinical or pathological conditions characterized by an infectious and/or inflammatory process that affects primarily the chorioamniotic membranes, but also the amniotic fluid, vessels of the chorionic plate, and, eventually, the umbilical cord (funisitis) and the fetus. Its incidence is higher at lower gestational ages, and the main mechanism is believed to be the ascending bacterial infection from the maternal genital tract. It can be diagnosed by clinical criteria, amniotic fluid examination for inflammatory mediators, and/or isolation of microorganisms, or by histopathological examination of the placenta. CA is an important cause of stillbirth and is related to an increased incidence of premature rupture of membranes, preterm delivery, and adverse maternal and neonatal outcomes such as early-onset neonatal sepsis and necrotizing enterocolitis. An independent causal association to other neonatal morbidities is more controversial. The heterogeneity in the diagnostic criteria and in the operative definitions for morbidity makes comparison of studies difficult, and results are inconsistent. In addition, the intensity and duration of the process are usually not considered. For all these reasons, evidence-based recommendations for the management of mother and infant under these circumstances are difficult to establish, and clinical practice varies widely.

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“…Exposing lambs to lipopolysaccharides (LPS, a TLR4 agonist) during gestation caused alterations of the cardiac tissue and function [56]. Some evidence has linked chorioamnionitis and patent ductus arteriosus, a prevalent cardiac defect in preterm newborns, but it is still controversial due to conflicting studies [57,58]. Inflammation and prematurity also seem to be involved in the development of arteriosclerosis and cardiovascular disease later in life [59].…”

Section: Heartmentioning

confidence: 99%

Preterm Birth: An Inflammatory Syndrome, Not Just A Myometrial Disorder

Mai-Vo¹,

Nadeau-Vallée²,

Beaudry-Richard³

2017

UOJM

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Preterm birth (PTB) is the leading cause of neonatal mortality and morbidity. Although the severity of neonatal outcomes is inversely correlated with gestational age, all PTBs can lead to potentially life-threatening neonatal outcomes and major lifelong health complications. Because advances in neonatal care have substantially decreased neonatal mortality, the incidence of PTB and its complications is unabatedly rising. PTB currently affects more than 10% of births worldwide, with similar numbers in developed countries. Correspondingly, improving neonatal outcome is a key objective of the World Health Organization. The recently approved (in Europe) tocolytics drug, Atosiban, used to prolong preterm gestation, has not been shown to improve neonatal outcome, nor have other tocolytic agents used in clinic. Thus, PTB remains an unmet medical need. Recent evidence shows that most, if not all, PTBs are associated with (overt or occult) inflammatory processes in gestational tissues, independent of infection. Proinflammatory cytokines are produced from maternal and fetal cells in response to sterile or infectious stressors. These seem to orchestrate a multi-tissue response including myometrial contractility, cervical ripening, and weakening/rupture of fetal membranes, leading to the onset of preterm labor. This integrated system might have been conserved through mammalian evolution due to increased maternal and/or fetal survival when gestation is terminated in specific settings, such as infection. Hence, inflammation may be a common pathway to the numerous aetiologies of PTB. Most importantly, recent evidence suggests that inflammation is transmitted to the fetus, thereby inducing organ injuries that may underlie the development of major neonatal diseases. Targeting inflammation prenatally instead of myometrial contraction could be a more successful and safe approach for the management of PTB, as suggested by recent animal studies. ABSTRACTLa naissance prématurée est la principale cause de mortalité et de morbidité néonatale. Bien que la sévérité des issus néonataux soit inversement corrélée avec l'âge gestationnel à la naissance, toutes les naissances prématurées peuvent mener à des issus néonataux potentiellement mortels et à des complications avec répercussions s'échelonnant sur toute la vie. Étant donné que la mortalité néonatale a considérablement diminuée avec les récentes avancées en néonatalogie, l'incidence de la naissance préma-turée et de ses complications sont en hausse. La naissance prématurée affecte présentement plus de 10% des naissances à travers le monde, avec des taux similaires dans les pays développés. Conséquemment, d'améliorer l'issu néonatal est un objectif clé de l'Organisation Mondiale de la Santé. Le tocolytique Atosiban récemment approuvé (en Europe) pour prolonger les gestations pré-maturées n'a pas démontré d'efficacité pour améliorer les issus néonataux, tout comme les autres tocolytiques utilisés en clinique, et la naissance prématurée demeure un besoin médical non-atteint. Des données r...

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

Cited by 35 publications

References 72 publications

Chorioamnionitis as a risk factor for retinopathy of prematurity: an updated systematic review and meta-analysis

Chorioamnionitis as a risk factor for retinopathy of prematurity: an updated systematic review and meta-analysis

Chorioamnionitis and neonatal morbidity: current perspectives

Preterm Birth: An Inflammatory Syndrome, Not Just A Myometrial Disorder

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